Provider Demographics
NPI:1235287442
Name:ANDRE, VICKI L (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:ANDRE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 OVERLAND AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7428
Mailing Address - Country:US
Mailing Address - Phone:406-256-7148
Mailing Address - Fax:406-256-0668
Practice Address - Street 1:2048 OVERLAND AVE
Practice Address - Street 2:STE 101
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7428
Practice Address - Country:US
Practice Address - Phone:406-256-7148
Practice Address - Fax:406-256-0668
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT534742Medicaid