Provider Demographics
NPI:1598020133
Name:KELLERMAN, ANDREA M
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:KELLERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DENNIS DR
Mailing Address - Street 2:SPECIAL SERVICES -- CLAIM CARE
Mailing Address - City:BISMARCK
Mailing Address - State:MO
Mailing Address - Zip Code:63624-9075
Mailing Address - Country:US
Mailing Address - Phone:573-734-6111
Mailing Address - Fax:573-734-2957
Practice Address - Street 1:101 DENNIS DR
Practice Address - Street 2:SPECIAL SERVICES -- CLAIM CARE
Practice Address - City:BISMARCK
Practice Address - State:MO
Practice Address - Zip Code:63624-9075
Practice Address - Country:US
Practice Address - Phone:573-734-6111
Practice Address - Fax:573-734-2957
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012020964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist