MEDICARE: MRS. JEAN ANNA EDWARDS M.S.T. CCC-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	1998-154	WI
2	235500000X	Speech/Language/Hearing Specialist/Technologist	1998-154	WI

General Provider Information

NPI Number	:	1245665744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN ANNA EDWARDS M.S.T. CCC-SLP

Provider Business Mailing Address
First Line	:	701 E 11TH ST
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2399
Country	:	US
Telephone Number	:	715-243-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E 11TH ST
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2399
Country	:	US
Telephone Number	:	715-243-1615
Fax Number	:

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

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	12/12/2017

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Directions to “ MRS. JEAN ANNA EDWARDS M.S.T. CCC-SLP” Practice Location

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