MEDICARE: HEATHER EDWARDS

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	2020022065	MO

General Provider Information

NPI Number	:	1275145237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER EDWARDS

Provider Business Mailing Address
First Line	:	12473 LAWRENCE 1245
Second Line	:
City	:	MARIONVILLE
State	:	MO
Zip	:	65705-8155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 S LINCOLN AVE
Second Line	:
City	:	AURORA
State	:	MO
Zip	:	65605-1824
Country	:	US
Telephone Number	:	417-678-7436
Fax Number	:

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

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	08/22/2023

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Directions to “ HEATHER EDWARDS ” Practice Location

Language	Start Address	Practice Location

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