Provider Demographics
NPI:1407097496
Name:PAQUETTE, ANDREA ROSE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ROSE
Last Name:PAQUETTE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MARY ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1930
Mailing Address - Country:US
Mailing Address - Phone:518-258-1352
Mailing Address - Fax:
Practice Address - Street 1:1020 MARY ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1930
Practice Address - Country:US
Practice Address - Phone:518-258-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016355-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist