Provider Demographics
NPI:1255694469
Name:GOERING, ANDREA (LMT)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:GOERING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2466
Mailing Address - Country:US
Mailing Address - Phone:913-530-1062
Mailing Address - Fax:
Practice Address - Street 1:401 E 10TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3317
Practice Address - Country:US
Practice Address - Phone:913-530-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15298174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist