Provider Demographics
NPI:1881867968
Name:GOSSELIN, ANDREA R (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:R
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:R
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:153 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4011
Mailing Address - Country:US
Mailing Address - Phone:401-276-4300
Mailing Address - Fax:
Practice Address - Street 1:153 SUMMER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4011
Practice Address - Country:US
Practice Address - Phone:401-276-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01007235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2092OtherEI NHPRC
RI412296OtherEI BCHIP
RI4600103OtherEI UNITED
RI292177OtherEI BCROSS