Provider Demographics
NPI:1114573466
Name:WIERZCHOWSKI, ANDREA ALISON
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ALISON
Last Name:WIERZCHOWSKI
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 1:6080 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5202
Mailing Address - Country:US
Mailing Address - Phone:469-646-0366
Mailing Address - Fax:469-458-2096
Practice Address - Street 1:6080 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5202
Practice Address - Country:US
Practice Address - Phone:469-646-0366
Practice Address - Fax:469-458-2096
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38877103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist