Provider Demographics
NPI:1356409189
Name:STAFFIN, ANDREA (MA CCC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:STAFFIN
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 1:13 AMARYLLIS LANE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:215-860-8699
Mailing Address - Fax:215-956-2838
Practice Address - Street 1:13 AMARYLLIS LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1248
Practice Address - Country:US
Practice Address - Phone:215-860-8699
Practice Address - Fax:215-956-2838
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000090L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist