Provider Demographics
NPI:1235281593
Name:ANDERSON, DIERDRE (AUD)
Entity Type:Individual
Prefix:
First Name:DIERDRE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-2445
Mailing Address - Country:US
Mailing Address - Phone:978-465-5321
Mailing Address - Fax:
Practice Address - Street 1:158 BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-2445
Practice Address - Country:US
Practice Address - Phone:978-465-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA362231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0021OtherBLUECROSS BLUESHIELD
MA2319512OtherCIGNA
MA5102537Medicaid
MA468876OtherTUFTS
MAAA2241OtherHARVARD PILGRIM
MA3401638OtherAETNA
MA5102537Medicaid