Provider Demographics
NPI:1477046803
Name:EDWARDS, ALYSSA (ECDS)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ECDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2730
Mailing Address - Country:US
Mailing Address - Phone:870-424-4021
Mailing Address - Fax:870-424-4112
Practice Address - Street 1:1310 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2730
Practice Address - Country:US
Practice Address - Phone:870-424-4021
Practice Address - Fax:870-424-4112
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist