MEDICARE: JOHEIDY 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	2355S0801X	Speech-Language Assistant	41808	TX

General Provider Information

NPI Number	:	1295319754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHEIDY EDWARDS

Provider Business Mailing Address
First Line	:	4700 N MESA ST STE F4
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6187
Country	:	US
Telephone Number	:	915-637-9524
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 N MESA ST STE F4
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6187
Country	:	US
Telephone Number	:	915-637-9524
Fax Number	:

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

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	05/11/2021

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Directions to “ JOHEIDY EDWARDS ” Practice Location

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