Provider Demographics
NPI:1992367015
Name:EDWARDS, CHELCEY MICHELLE (SLP)
Entity type:Individual
Prefix:MS
First Name:CHELCEY
Middle Name:MICHELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 JACK RUSSELL CT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8356
Mailing Address - Country:US
Mailing Address - Phone:803-354-1143
Mailing Address - Fax:
Practice Address - Street 1:736 JACK RUSSELL CT
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8356
Practice Address - Country:US
Practice Address - Phone:803-354-1143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC85-1249089Medicaid