Provider Demographics
NPI:1144868266
Name:EDENS, AMBER TOURVILLE (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:TOURVILLE
Last Name:EDENS
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MARIANNAS CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8050
Mailing Address - Country:US
Mailing Address - Phone:803-707-7993
Mailing Address - Fax:
Practice Address - Street 1:100 TARRAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3835
Practice Address - Country:US
Practice Address - Phone:803-821-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist