Provider Demographics
NPI:1942499678
Name:MCANDREWS, KATHLEEN MARGENAU
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARGENAU
Last Name:MCANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:ORACLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85623-6039
Mailing Address - Country:US
Mailing Address - Phone:520-896-3100
Mailing Address - Fax:
Practice Address - Street 1:650 W LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:ORACLE
Practice Address - State:AZ
Practice Address - Zip Code:85623-6039
Practice Address - Country:US
Practice Address - Phone:520-896-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ625478Medicaid