Provider Demographics
NPI:1255462891
Name:EDWARDS, BO KYUNG (MS/CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BO
Middle Name:KYUNG
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS/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:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-0953
Mailing Address - Country:US
Mailing Address - Phone:828-329-6010
Mailing Address - Fax:
Practice Address - Street 1:167 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-2702
Practice Address - Country:US
Practice Address - Phone:828-329-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist