Provider Demographics
NPI:1659815918
Name:HURST-HOPF, ANDREA EVELYN (MACCC SP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:EVELYN
Last Name:HURST-HOPF
Suffix:
Gender:F
Credentials:MACCC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 SUTTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6627
Mailing Address - Country:US
Mailing Address - Phone:408-206-7446
Mailing Address - Fax:
Practice Address - Street 1:2321 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6627
Practice Address - Country:US
Practice Address - Phone:408-206-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA271585133OtherEIN