Provider Demographics
NPI:1164046264
Name:ESHELMAN, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ESHELMAN
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 1:31755 DAY LILY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-8773
Mailing Address - Country:US
Mailing Address - Phone:734-775-2638
Mailing Address - Fax:
Practice Address - Street 1:31755 DAY LILY DR
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173-8773
Practice Address - Country:US
Practice Address - Phone:734-775-2638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8101001834235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist