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NPI Code Detail

MEDICARE: ANDREW WHITEHEAD M.A., CCC-SLP

MEDICARE: ANDREW WHITEHEAD M.A., CCC-SLP
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
1235Z00000XSpeech-Language Pathologist7364MN

General Provider Information

NPI Number : 1023425717
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW WHITEHEAD M.A., CCC-SLP
Provider Business Mailing Address
First Line : 705 4TH ST SE
Second Line : APT A
City : WASECA
State : MN
Zip : 56093-3064
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 815 FOREST AVE
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-1643
Country : US
Telephone Number : 507-664-8841
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2014
Last Update Date : 07/15/2014

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