Provider Demographics
NPI:1134265374
Name:DUPUY, ANDREA KRISTIN (SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KRISTIN
Last Name:DUPUY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 ZIRCON DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5117
Mailing Address - Country:US
Mailing Address - Phone:402-990-7277
Mailing Address - Fax:
Practice Address - Street 1:914 4TH ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002
Practice Address - Country:US
Practice Address - Phone:253-931-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE126235Z00000X
WALL60107089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477700Medicaid