Provider Demographics
NPI:1467686055
Name:GAST, ANDREA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GAST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:D'ANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:605 CALAMAR CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7088
Mailing Address - Country:US
Mailing Address - Phone:314-265-6440
Mailing Address - Fax:
Practice Address - Street 1:605 CALAMAR CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7088
Practice Address - Country:US
Practice Address - Phone:314-265-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114060235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09145765OtherASHA
MO114060OtherSTATE OF MISSOURI 114060