Provider Demographics
NPI:1225189319
Name:LOUDERMILK-SHULL, ANDREA L (MS, CCC, SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:LOUDERMILK-SHULL
Suffix:
Gender:F
Credentials:MS, CCC, SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:LOUDERMILK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 9
Mailing Address - Street 2:BOX 5975
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09123-0060
Mailing Address - Country:US
Mailing Address - Phone:0049-656-5933
Mailing Address - Fax:
Practice Address - Street 1:52 MDOS/SGOV
Practice Address - Street 2:UNIT 3690
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126
Practice Address - Country:US
Practice Address - Phone:004-965-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist