Provider Demographics
NPI:1124211461
Name:GUIDETTI, ANDREA NICOLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NICOLE
Last Name:GUIDETTI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:NICOLE
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3320 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1813
Mailing Address - Country:US
Mailing Address - Phone:508-333-4258
Mailing Address - Fax:
Practice Address - Street 1:3320 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1813
Practice Address - Country:US
Practice Address - Phone:508-333-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6877235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist