Provider Demographics
NPI:1417956541
Name:ANDRZEJEWSKI, RENEE (AUD,CCC-A)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ANDRZEJEWSKI
Suffix:
Gender:F
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 W STATE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1938
Mailing Address - Country:US
Mailing Address - Phone:716-372-7205
Mailing Address - Fax:716-372-4792
Practice Address - Street 1:2223 W STATE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1938
Practice Address - Country:US
Practice Address - Phone:716-372-7205
Practice Address - Fax:716-372-4792
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001168231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01111706Medicaid
NY01111706Medicaid
NYDD6619Medicare ID - Type Unspecified