Provider Demographics
NPI:1073181459
Name:PAASCH, ANDREA THERESE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:THERESE
Last Name:PAASCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 SW 19TH ST APT 23302
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3037
Mailing Address - Country:US
Mailing Address - Phone:620-249-8015
Mailing Address - Fax:
Practice Address - Street 1:410 PEACH AVE
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-6090
Practice Address - Country:US
Practice Address - Phone:620-249-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCF346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200993090AMedicaid