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General NPI Number Information
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NPI Number | 1679486542
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Entity Type | Individual
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Provider Name | IDA LEE EDEN MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 549 N RACE ST
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City | STATESVILLE
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State | NC
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Zip | 28677-3915
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Country | US
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Telephone | 704-872-8931
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Fax |
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Provider Business Mailing Address
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Address Line | 312 SADIE MAE DR
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City | LEXINGTON
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State | NC
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Zip | 27295-7718
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Country | US
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Telephone |
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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 | 30001565
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License Number State | NC
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