Provider Demographics
NPI:1598018087
Name:TOMLINSON, ANDREA (SLP)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:TOMLINSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-1590
Mailing Address - Country:US
Mailing Address - Phone:606-679-1811
Mailing Address - Fax:
Practice Address - Street 1:190 SHAFTER SHEPOLA RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-6222
Practice Address - Country:US
Practice Address - Phone:606-679-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12-083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist