Provider Demographics
NPI:1043594054
Name:POIRIER, ANDREA L (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:POIRIER
Suffix:
Gender:F
Credentials:MA 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:PO BOX 260
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-0260
Mailing Address - Country:US
Mailing Address - Phone:732-233-5117
Mailing Address - Fax:
Practice Address - Street 1:445 WILLOWBROOK DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1240
Practice Address - Country:US
Practice Address - Phone:732-233-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00676700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist