Provider Demographics
NPI:1093904674
Name:FORTMAN, ANDREA ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:ROSE
Last Name:FORTMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 PORTLOCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9257
Mailing Address - Country:US
Mailing Address - Phone:614-581-8643
Mailing Address - Fax:
Practice Address - Street 1:37 TRIANGLE PARK DR
Practice Address - Street 2:SUITE 3702
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3411
Practice Address - Country:US
Practice Address - Phone:513-772-4039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-7972235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist