Provider Demographics
NPI:1265953962
Name:ANDRA, DEVON FRANCES
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:FRANCES
Last Name:ANDRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2313 E SUMMERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8658
Mailing Address - Country:US
Mailing Address - Phone:316-706-4591
Mailing Address - Fax:
Practice Address - Street 1:1820 N TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4902
Practice Address - Country:US
Practice Address - Phone:316-706-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4918235Z00000X
KS3583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist