Provider Demographics
NPI:1336650480
Name:SCHEBLEIN, ANDREA D
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:SCHEBLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6292 BRAIDWOOD RUN NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3534
Mailing Address - Country:US
Mailing Address - Phone:404-547-6554
Mailing Address - Fax:
Practice Address - Street 1:3105 CREEKSIDE VILLAGE DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2394
Practice Address - Country:US
Practice Address - Phone:770-974-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist