MEDICARE: EMMA EDGAR MS CF SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	271768	KY

General Provider Information

NPI Number	:	1538817200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA EDGAR MS CF SLP

Provider Business Mailing Address
First Line	:	4030 TATES CREEK RD APT 5103
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3187
Country	:	US
Telephone Number	:	502-553-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 TATES CREEK RD APT 5103
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-3187
Country	:	US
Telephone Number	:	502-553-8413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2022
Last Update Date	:	03/12/2022

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