Provider Demographics
NPI:1174631204
Name:SWEETNAM, ANDREA (AUDIOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:SWEETNAM
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SWEETNAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUDIOLOGIST
Mailing Address - Street 1:1600 MEDICAL CENTER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5008
Mailing Address - Country:US
Mailing Address - Phone:915-544-1350
Mailing Address - Fax:915-544-6740
Practice Address - Street 1:1600 MEDICAL CENTER ST STE 101
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5008
Practice Address - Country:US
Practice Address - Phone:915-544-1350
Practice Address - Fax:915-544-6740
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51358231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist