Provider Demographics
NPI:1073177374
Name:CHRISTLER, ANDREW KENNETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KENNETH
Last Name:CHRISTLER
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 W 52ND ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6360
Mailing Address - Country:US
Mailing Address - Phone:313-421-2166
Mailing Address - Fax:
Practice Address - Street 1:458 W 52ND ST APT 2D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6360
Practice Address - Country:US
Practice Address - Phone:313-421-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist