MEDICARE: KAITLYN ANDREASON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	TSLP8362	AZ
2	235Z00000X	Speech-Language Pathologist	558101	UT

General Provider Information

NPI Number	:	1417397654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ANDREASON

Provider Business Mailing Address
First Line	:	17100 E SHEA BLVD
Second Line	:	SUITE 225
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-6625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 E FRYE RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-5114
Country	:	US
Telephone Number	:	480-883-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	06/06/2014

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Directions to “ KAITLYN ANDREASON ” Practice Location

Language	Start Address	Practice Location

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