Provider Demographics
NPI:1700900545
Name:DOGGETT, ANDREA J
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:J
Last Name:DOGGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:J
Other - Last Name:DOGGETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC
Mailing Address - Street 1:8804 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8804 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4230
Practice Address - Country:US
Practice Address - Phone:515-278-9542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist