Provider Demographics
NPI:1194265124
Name:CHARLES, EDWIGE
Entity type:Individual
Prefix:
First Name:EDWIGE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 RHODE ISLAND AVE NE
Mailing Address - Street 2:SUITE I
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1269
Mailing Address - Country:US
Mailing Address - Phone:202-575-5404
Mailing Address - Fax:
Practice Address - Street 1:15206 NAUGHTON DR
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1115
Practice Address - Country:US
Practice Address - Phone:708-299-9714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP001072235Z00000X
IL146015176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist