Healthcare Provider Details

I. General information

NPI: 1720051766
Provider Name (Legal Business Name): INGRID EDWARDS AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E KENTUCKY ST
LOUISVILLE KY
40203-2793
US

IV. Provider business mailing address

111 E KENTUCKY ST
LOUISVILLE KY
40203-2793
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-3573
  • Fax: 502-583-6364
Mailing address:
  • Phone: 502-515-3320
  • Fax: 502-515-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0312
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0727
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: