Provider Demographics
NPI:1245752708
Name:SARKAUSKAS, ANDREA MATTIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MATTIE
Last Name:SARKAUSKAS
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 1:5290 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-4906
Mailing Address - Country:US
Mailing Address - Phone:320-905-5369
Mailing Address - Fax:
Practice Address - Street 1:5290 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-4906
Practice Address - Country:US
Practice Address - Phone:637-280-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9864235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist