Provider Demographics
NPI:1801977145
Name:FROST, ANDREA (MA, CCC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:FROST
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:HC 74 BOX 20512
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-9505
Mailing Address - Country:US
Mailing Address - Phone:505-758-4308
Mailing Address - Fax:
Practice Address - Street 1:HC 74 BOX 20512
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-9505
Practice Address - Country:US
Practice Address - Phone:505-758-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist