1285706085 NPI number — KRISTINE E ANDREW MS CCC SLP

Table of content: KRISTINE E ANDREW MS CCC SLP (NPI 1285706085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285706085 NPI number — KRISTINE E ANDREW MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREW
Provider First Name:
KRISTINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOTHBERG
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
ANDREW
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285706085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3445 POST ROAD
Provider Second Line Business Mailing Address:
J ARTHUR TRUDEAU MEMORIAL CENTER ATTN KIM RUELLE HR
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-7147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-739-2700
Provider Business Mailing Address Fax Number:
401-737-8907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3445 POST ROAD
Provider Second Line Business Practice Location Address:
J ARTHUR TRUDEAU MEMORIAL CENTER ATTN KIM RUELLE HR
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-7147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-739-2700
Provider Business Practice Location Address Fax Number:
401-737-8907
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0177 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: KC02260 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4224 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 294096 . This is a "BCBS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4600113 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 412372 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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