Provider Demographics
NPI:1467508739
Name:NICKDOW, ANDREA LAUREN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LAUREN
Last Name:NICKDOW
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 1:1 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1342
Mailing Address - Country:US
Mailing Address - Phone:631-567-0514
Mailing Address - Fax:
Practice Address - Street 1:45 CROSSWAY E
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1204
Practice Address - Country:US
Practice Address - Phone:631-218-4949
Practice Address - Fax:631-567-3640
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009266-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist