Provider Demographics
NPI:1225412182
Name:BLUM, ANDREA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BLUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11479 PINE DR OFC 1
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7308
Mailing Address - Country:US
Mailing Address - Phone:303-840-6374
Mailing Address - Fax:
Practice Address - Street 1:11479 PINE DR OFC 1
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7308
Practice Address - Country:US
Practice Address - Phone:303-840-6374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2024-03-05
Deactivation Date:2019-05-07
Deactivation Code:
Reactivation Date:2024-03-05
Provider Licenses
StateLicense IDTaxonomies
IL146010806235Z00000X
COSLP.0001863235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist