Individual
MRS. BECKY J EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
346 ALANA DR, NEW LENOX, IL 60451-1784
(815) 462-0514
Mailing address
2606 MOLLY CT, NEW LENOX, IL 60451-3088
(815) 462-0515
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9134309
ASHA
—
01
—
9932126
BCBS
IL
Enumeration date
01/29/2007
Last updated
07/08/2007
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