1770784159 NPI number — REGINA C. EDWARDS, MA CCC-SLP, PA

Table of content: (NPI 1770784159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770784159 NPI number — REGINA C. EDWARDS, MA CCC-SLP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGINA C. EDWARDS, MA CCC-SLP, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770784159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825-C MERRIMON AVE.
Provider Second Line Business Mailing Address:
#395
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28804-2402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-768-4462
Provider Business Mailing Address Fax Number:
828-225-2761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 WESTGATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28806-3023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-768-4462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
REGINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
828-768-4462

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  8300183K , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8300183K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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