Provider Demographics
NPI:1811650955
Name:EDENS, ELIZABETH FAYE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAYE
Last Name:EDENS
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 1:14937 PLEASANT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:DISPUTANTA
Mailing Address - State:VA
Mailing Address - Zip Code:23842-4022
Mailing Address - Country:US
Mailing Address - Phone:804-731-3912
Mailing Address - Fax:
Practice Address - Street 1:5501 CONDUIT RD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2121
Practice Address - Country:US
Practice Address - Phone:804-524-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist