Provider Demographics
NPI:1013182385
Name:MANN, ANDREA LORENE (MA CCC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LORENE
Last Name:MANN
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PINE NEEDLE RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-0436
Mailing Address - Country:US
Mailing Address - Phone:303-449-0880
Mailing Address - Fax:303-938-8045
Practice Address - Street 1:27 PINE NEEDLE RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0436
Practice Address - Country:US
Practice Address - Phone:303-449-0880
Practice Address - Fax:303-938-8045
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist