Healthcare Provider Details

I. General information

NPI: 1457879702
Provider Name (Legal Business Name): ANDREA PARR MS/CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W GRAND AVE
BELOIT WI
53511-5933
US

IV. Provider business mailing address

1515 W GRAND AVE
BELOIT WI
53511-5933
US

V. Phone/Fax

Practice location:
  • Phone: 608-361-2300
  • Fax:
Mailing address:
  • Phone: 608-361-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1001407428
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146013055
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: