Individual provider Active NPI

Deja Renee Edmond, SLP

  • Speech-Language Pathologist
  • Baytown, TX
National Provider Identifier
1356974331
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
120122 Issued in TX
Practice address
5313 Decker Dr
Baytown, TX 77520-1413
Phone
(281) 838-4477
NPI assigned
Feb 18, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 120122 TX Primary

Addresses

Primary practice location

5313 Decker Dr
Baytown, TX 77520-1413

Mailing address

5313 Decker Dr
Baytown, TX 77520-1413
Phone (281) 838-4477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35939CAMDLicensed Psychiatric Technician
120122TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Interface Rehab, Inc. CurrentSince Mar 12, 2024 Accepting new patients
Bay Area Rehabilitation Center Past Accepting new patients

Locations

774 S Placentia Ave
Ste 200
Placentia, CA 92870
Phone (714) 646-8300

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1356974331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5313 DECKER DR",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775201413",
            "telephone_number": "281-838-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5313 DECKER DR",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775201413",
            "telephone_number": "281-838-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMOND",
        "first_name": "DEJA",
        "middle_name": "RENEE",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "120122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baytown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.