Provider Demographics
NPI:1215124318
Name:MILSTEAD, EDITH ANN (MS,CCC)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:ANN
Last Name:MILSTEAD
Suffix:
Gender:F
Credentials:MS,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 SPILLWAY RD STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6079
Mailing Address - Country:US
Mailing Address - Phone:601-992-5370
Mailing Address - Fax:601-992-5370
Practice Address - Street 1:3826 KING RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-3573
Practice Address - Country:US
Practice Address - Phone:601-485-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist