Provider Demographics
NPI:1447037361
Name:EDMONSON, TERRY LYNN (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LYNN
Last Name:EDMONSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 HAND CT
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1749
Mailing Address - Country:US
Mailing Address - Phone:410-596-0689
Mailing Address - Fax:
Practice Address - Street 1:9919 MARRIOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-1503
Practice Address - Country:US
Practice Address - Phone:443-809-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist