Provider Demographics
NPI:1255182671
Name:TOMES, ANDREA ROSE (HIS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:TOMES
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ROSE
Other - Last Name:PECNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 N JEBAVY DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1923
Mailing Address - Country:US
Mailing Address - Phone:231-843-7019
Mailing Address - Fax:
Practice Address - Street 1:325 N JEBAVY DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1923
Practice Address - Country:US
Practice Address - Phone:231-843-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI350201277237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist