Active NPI
Lynette Marie Edwards, CCC-SLP
- Speech-Language Pathologist
- Waterford, WI
National Provider Identifier
1407092380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 146007204
- Practice address
- 653 Hickory Hollow Rd
Waterford, WI 53185-2888 - Phone
- (262) 994-2684
- NPI assigned
- Dec 26, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146007204 | IL | Primary |
Addresses
Primary practice location
653 Hickory Hollow Rd
Waterford, WI 53185-2888
Mailing address
653 Hickory Hollow Rd
Waterford, WI 53185-2888
Phone (262) 994-2684
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146007204 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230249600000",
"number": "1407092380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "653 HICKORY HOLLOW RD",
"city": "WATERFORD",
"state": "WI",
"postal_code": "531852888",
"telephone_number": "262-994-2684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "653 HICKORY HOLLOW RD",
"city": "WATERFORD",
"state": "WI",
"postal_code": "531852888",
"telephone_number": "262-994-2684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "LYNETTE",
"middle_name": "MARIE",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-12-26",
"last_updated": "2008-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "146007204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterford, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.