Provider Demographics
NPI:1104168087
Name:COLON, EDDA A (MS/PHL)
Entity type:Individual
Prefix:MS
First Name:EDDA
Middle Name:A
Last Name:COLON
Suffix:
Gender:F
Credentials:MS/PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. JARDINES C/9 L-11
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-1924
Mailing Address - Country:US
Mailing Address - Phone:787-674-4020
Mailing Address - Fax:787-592-1564
Practice Address - Street 1:CARR 153 KM 7.5 BO USERAS
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2762
Practice Address - Country:US
Practice Address - Phone:787-674-4020
Practice Address - Fax:787-592-1564
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist