MEDICARE: IVY NIKOLE EDWARDS M.S., 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	14355552	KY

General Provider Information

NPI Number	:	1568128429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY NIKOLE EDWARDS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	406 S 6TH ST
Second Line	:
City	:	MURRAY
State	:	KY
Zip	:	42071-2608
Country	:	US
Telephone Number	:	270-227-4349
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 S 6TH ST
Second Line	:
City	:	MURRAY
State	:	KY
Zip	:	42071-2608
Country	:	US
Telephone Number	:	270-227-4349
Fax Number	:

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

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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Directions to “ IVY NIKOLE EDWARDS M.S., CCC-SLP” Practice Location

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