Provider Demographics
NPI:1235297102
Name:MANIGAULT, ANDREA DENEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:DENEE
Last Name:MANIGAULT
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 1:114 QUAIL CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1967
Mailing Address - Country:US
Mailing Address - Phone:914-243-7296
Mailing Address - Fax:
Practice Address - Street 1:1607 ROUTE 300
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1738
Practice Address - Country:US
Practice Address - Phone:845-564-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist