Provider Demographics
NPI:1831564178
Name:ANDRADA, KIYOMI KATHERINE
Entity type:Individual
Prefix:
First Name:KIYOMI
Middle Name:KATHERINE
Last Name:ANDRADA
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 1:173 LONG HILL DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4500
Mailing Address - Country:US
Mailing Address - Phone:860-335-2323
Mailing Address - Fax:
Practice Address - Street 1:173 LONG HILL DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4500
Practice Address - Country:US
Practice Address - Phone:860-335-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-12
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant