Provider Demographics
NPI:1710709761
Name:GURBA, ANDREA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:GURBA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAMBERTVILLE HQ RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-1909
Mailing Address - Country:US
Mailing Address - Phone:609-397-1528
Mailing Address - Fax:
Practice Address - Street 1:124 LAMBERTVILLE HQ RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:NJ
Practice Address - Zip Code:08559-1909
Practice Address - Country:US
Practice Address - Phone:609-397-1528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00745800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist