Provider Demographics
NPI:1750589222
Name:CARD, ANDREA THERESE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:THERESE
Last Name:CARD
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 1:438 S KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-1752
Mailing Address - Country:US
Mailing Address - Phone:570-929-2302
Mailing Address - Fax:
Practice Address - Street 1:1000 W 27TH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-9604
Practice Address - Country:US
Practice Address - Phone:570-454-8888
Practice Address - Fax:570-459-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004686L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist