Provider Demographics
NPI:1295069441
Name:HAYES, ANDREA MICHELLE (MS,CCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:HAYES
Suffix:
Gender:F
Credentials:MS,CCC
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,CCC
Mailing Address - Street 1:689 W. FOOTHILL BLVD.,
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3400
Mailing Address - Country:US
Mailing Address - Phone:909-624-8244
Mailing Address - Fax:909-624-8234
Practice Address - Street 1:689 W. FOOTHILL BLVD.,
Practice Address - Street 2:SUITE B
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3400
Practice Address - Country:US
Practice Address - Phone:909-624-8244
Practice Address - Fax:909-624-8234
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist