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General NPI Number Information
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NPI Number | 1649916172
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Entity Type | Individual
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Provider Name | JENNIFER MICHELLE YATES EDMONDS M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 132 AMER CIR
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City | MADISON HEIGHTS
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State | VA
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Zip | 24572-2613
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Country | US
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Telephone | 434-528-6498
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Fax |
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Provider Business Mailing Address
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Address Line | 7008 RICHLAND DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-2017
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Country | US
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Telephone | 434-941-5328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202003781
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License Number State | VA
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