Provider Demographics
NPI:1629126701
Name:REDD, ANDREA JEAN (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JEAN
Last Name:REDD
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3978 HONEYSUCKLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37034-2099
Mailing Address - Country:US
Mailing Address - Phone:931-364-4594
Mailing Address - Fax:931-359-8139
Practice Address - Street 1:1653 MOORESVILLE HWY
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2005
Practice Address - Country:US
Practice Address - Phone:931-359-4506
Practice Address - Fax:931-359-8139
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist