Provider Demographics
NPI:1275228538
Name:VANDERHEIDEN, ANDREA (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:VANDERHEIDEN
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:GERRITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH PATHOLOGIST
Mailing Address - Street 1:25150 N FUHRMAN RD
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9350
Mailing Address - Country:US
Mailing Address - Phone:209-663-1586
Mailing Address - Fax:
Practice Address - Street 1:25150 N FUHRMAN RD
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9350
Practice Address - Country:US
Practice Address - Phone:209-663-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist