Provider Demographics
NPI:1639744261
Name:MAGEE, ANDREA T
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:MAGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:TANESHA
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2281 WAITE ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-2971
Mailing Address - Country:US
Mailing Address - Phone:708-577-3000
Mailing Address - Fax:
Practice Address - Street 1:1130 S CANAL ST # 1044
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4907
Practice Address - Country:US
Practice Address - Phone:501-683-9365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker