Provider Demographics
NPI:1831490218
Name:TRAVES, ANDREA (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:TRAVES
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:GAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2505 LAKEVIEW DR
Mailing Address - Street 2:STE 302
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1527
Mailing Address - Country:US
Mailing Address - Phone:806-358-8974
Mailing Address - Fax:806-359-0506
Practice Address - Street 1:2505 LAKEVIEW DR
Practice Address - Street 2:STE 302
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1527
Practice Address - Country:US
Practice Address - Phone:806-358-8974
Practice Address - Fax:806-359-0506
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist