1467787333 NPI number — AMY ANDREWS SPEECH THERAPIST

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467787333 NPI number — AMY ANDREWS SPEECH THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPEECH THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467787333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1560 HENTHORNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43537-1371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-866-5275
Provider Business Mailing Address Fax Number:
419-866-5663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 E FRONT ST
Provider Second Line Business Practice Location Address:
STE 135 B
Provider Business Practice Location Address City Name:
PEMBERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43450-7105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-287-3399
Provider Business Practice Location Address Fax Number:
419-287-3355
Provider Enumeration Date:
10/12/2009

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 , with the licence number:  SP4720 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2526654 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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