Provider Demographics
NPI:1477985141
Name:POLITSCH, ANDREA V (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:V
Last Name:POLITSCH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 PROGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1109
Mailing Address - Country:US
Mailing Address - Phone:815-220-6751
Mailing Address - Fax:
Practice Address - Street 1:4401 PROGRESS BLVD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1109
Practice Address - Country:US
Practice Address - Phone:815-220-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist