MEDICARE: ANDREA JANE ANDERSON

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	2355S0801X	Speech-Language Assistant	44321	TX

General Provider Information

NPI Number	:	1669284139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA JANE ANDERSON

Provider Business Mailing Address
First Line	:	2106 SANDRA LN
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-2232
Country	:	US
Telephone Number	:	717-614-9131
Fax Number	:

Provider Business Practice Location Address
First Line	:	2106 SANDRA LN
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-2232
Country	:	US
Telephone Number	:	717-614-9131
Fax Number	:

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

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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Directions to “ ANDREA JANE ANDERSON ” Practice Location

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