Provider Demographics
NPI:1578865515
Name:ANDREA GOTTLIEB MS CCC SLP INC
Entity Type:Organization
Organization Name:ANDREA GOTTLIEB MS CCC SLP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:561-329-7434
Mailing Address - Street 1:790 ANDREWS AVE
Mailing Address - Street 2:APTC206
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-7243
Mailing Address - Country:US
Mailing Address - Phone:561-329-7434
Mailing Address - Fax:561-278-6468
Practice Address - Street 1:790 ANDREWS AVE
Practice Address - Street 2:APTC206
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-7243
Practice Address - Country:US
Practice Address - Phone:561-329-7434
Practice Address - Fax:561-278-6468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILSA5309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty