Provider Demographics
NPI:1821179680
Name:MILBURN, ANDREA (MS)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:MILBURN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-4853
Mailing Address - Country:US
Mailing Address - Phone:540-433-3100
Mailing Address - Fax:540-432-6989
Practice Address - Street 1:463 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-4853
Practice Address - Country:US
Practice Address - Phone:540-433-3100
Practice Address - Fax:540-432-6989
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008400235Z00000X
VA220200503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015341750002Medicaid
PA1015341750003Medicaid