Provider Demographics
NPI:1235303421
Name:KELLOGG, ANDREA L (MA SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:KEHRWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6091 S QUEBEC ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4521
Mailing Address - Country:US
Mailing Address - Phone:303-504-9945
Mailing Address - Fax:303-504-9946
Practice Address - Street 1:6091 S QUEBEC ST STE 200
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4521
Practice Address - Country:US
Practice Address - Phone:303-504-9945
Practice Address - Fax:303-504-9946
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1125862235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist