Provider Demographics
NPI:1609499037
Name:POLLOCK, ANDREA FLORENCE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:FLORENCE
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 HAMPTON WOODS DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5402
Mailing Address - Country:US
Mailing Address - Phone:770-910-0231
Mailing Address - Fax:
Practice Address - Street 1:1270 MCCONNELL DR STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3507
Practice Address - Country:US
Practice Address - Phone:770-982-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist