Provider Demographics
NPI:1164548863
Name:CARRICO, ANDREA
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:CARRICO
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 1:21 LAFAYETTE CIR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9242
Mailing Address - Country:US
Mailing Address - Phone:304-757-8390
Mailing Address - Fax:
Practice Address - Street 1:1000 ASSOCIATION DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1270
Practice Address - Country:US
Practice Address - Phone:304-347-4372
Practice Address - Fax:304-347-8526
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist