MEDICARE: MARCY ANNA EDSON M.S. 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	9859	CA

General Provider Information

NPI Number	:	1891020822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCY ANNA EDSON M.S. SLP

Provider Business Mailing Address
First Line	:	44898 CORTE SIERRA
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92592-1090
Country	:	US
Telephone Number	:	760-586-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	9466 BLACK MOUNTAIN RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4550
Country	:	US
Telephone Number	:	858-689-2027
Fax Number	:

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

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	06/17/2019

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