Provider Demographics
NPI:1588808919
Name:ANDREANO, KELLY J (MS, CCC-LSLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:ANDREANO
Suffix:
Gender:F
Credentials:MS, CCC-LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-3801
Mailing Address - Country:US
Mailing Address - Phone:716-378-4010
Mailing Address - Fax:
Practice Address - Street 1:711 E STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3801
Practice Address - Country:US
Practice Address - Phone:716-378-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010468235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist