Provider Demographics
NPI:1578159810
Name:NEWBURRY, ANDREA JOYCE (MA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOYCE
Last Name:NEWBURRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CEDAR OAK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1735
Mailing Address - Country:US
Mailing Address - Phone:636-697-6425
Mailing Address - Fax:
Practice Address - Street 1:872 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-8408
Practice Address - Country:US
Practice Address - Phone:573-302-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021003153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist