Provider Demographics
NPI:1679858609
Name:CLEMENTS, ANDREA KRISTIN (SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KRISTIN
Last Name:CLEMENTS
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 1:3123 ALDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1017
Mailing Address - Country:US
Mailing Address - Phone:360-671-3660
Mailing Address - Fax:
Practice Address - Street 1:3123 ALDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1017
Practice Address - Country:US
Practice Address - Phone:360-671-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60209970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist