Provider Demographics
NPI:1528212016
Name:KLIVECKA, ANDRA (MA, SLP, CCC)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:
Last Name:KLIVECKA
Suffix:
Gender:F
Credentials:MA, SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PONDFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1110
Mailing Address - Country:US
Mailing Address - Phone:914-663-8687
Mailing Address - Fax:
Practice Address - Street 1:15 PONDFIELD PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1110
Practice Address - Country:US
Practice Address - Phone:914-663-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist