Provider Demographics
NPI:1942648209
Name:BETTIS, ANDREA E (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:BETTIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20000 VICTOR PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7027
Mailing Address - Country:US
Mailing Address - Phone:734-743-2909
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:20000 VICTOR PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7027
Practice Address - Country:US
Practice Address - Phone:734-743-2909
Practice Address - Fax:734-953-1743
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist