Provider Demographics
NPI:1356560429
Name:PRICE, ANDREA MARSALA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARSALA
Last Name:PRICE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 FAWN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1482
Mailing Address - Country:US
Mailing Address - Phone:239-826-5100
Mailing Address - Fax:239-561-6352
Practice Address - Street 1:8925 FAWN RIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1482
Practice Address - Country:US
Practice Address - Phone:239-561-6350
Practice Address - Fax:239-561-6352
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist