Provider Demographics
NPI:1477313708
Name:GILL, ANDREA DAWN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DAWN
Last Name:GILL
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 1:63 COUNTY ROAD 1019
Mailing Address - Street 2:
Mailing Address - City:CUNNINGHAM
Mailing Address - State:KY
Mailing Address - Zip Code:42035-9491
Mailing Address - Country:US
Mailing Address - Phone:270-556-8963
Mailing Address - Fax:
Practice Address - Street 1:100 MARSHALL CT
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9639
Practice Address - Country:US
Practice Address - Phone:270-442-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY136957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist