Provider Demographics
NPI:1760031868
Name:BAE, ANDREA CHI-LING (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHI-LING
Last Name:BAE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CHI-LING
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3845 W 4700 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-3454
Mailing Address - Country:US
Mailing Address - Phone:801-840-4382
Mailing Address - Fax:
Practice Address - Street 1:3845 W 4700 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-3454
Practice Address - Country:US
Practice Address - Phone:801-840-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty