Provider Demographics
NPI:1508267766
Name:CIRO, ANDREA MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:CIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 W MANN AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2267
Mailing Address - Country:US
Mailing Address - Phone:575-317-5417
Mailing Address - Fax:
Practice Address - Street 1:301 BULLDOG BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1731
Practice Address - Country:US
Practice Address - Phone:575-746-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP6835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist