Provider Demographics
NPI:1184231524
Name:GUERRERO, ANDREA WENCESLADA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:WENCESLADA
Last Name:GUERRERO
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 1:5991 LOURDES BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-6980
Mailing Address - Country:US
Mailing Address - Phone:956-639-2174
Mailing Address - Fax:
Practice Address - Street 1:222 N EXPRESSWAY 77/83 STE 104
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2258
Practice Address - Country:US
Practice Address - Phone:956-479-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX416012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant