Provider Demographics
NPI:1801557194
Name:D'ANDREA, KALI ROSE
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:ROSE
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WASHINGTON ST APT 18
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2841
Mailing Address - Country:US
Mailing Address - Phone:435-881-1193
Mailing Address - Fax:
Practice Address - Street 1:875 WASHINGTON ST APT 18
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2841
Practice Address - Country:US
Practice Address - Phone:435-881-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty