Provider Demographics
NPI:1083860555
Name:PARKER, ANDREA L (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 IRENE BRIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:HICKORY GROVE
Mailing Address - State:SC
Mailing Address - Zip Code:29717-8776
Mailing Address - Country:US
Mailing Address - Phone:704-299-2035
Mailing Address - Fax:
Practice Address - Street 1:2911 IRENE BRIDGE HWY
Practice Address - Street 2:
Practice Address - City:HICKORY GROVE
Practice Address - State:SC
Practice Address - Zip Code:29717-8776
Practice Address - Country:US
Practice Address - Phone:704-299-2035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI922235Z00000X
NC8234235Z00000X
IL146009549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist