Provider Demographics
NPI:1053890335
Name:EDWARDS, SONYA LYNN (SLP-ASSISTANT)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W LINGLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2211
Mailing Address - Country:US
Mailing Address - Phone:125-496-5361
Mailing Address - Fax:
Practice Address - Street 1:315 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5413
Practice Address - Country:US
Practice Address - Phone:940-325-1516
Practice Address - Fax:254-965-3618
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367322355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172242301Medicaid