Provider Demographics
NPI:1841469624
Name:SIMONSON, ANDREA M (PHD, CCC-A)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:SIMONSON
Suffix:
Gender:F
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1232
Mailing Address - Country:US
Mailing Address - Phone:617-524-3864
Mailing Address - Fax:
Practice Address - Street 1:560 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1232
Practice Address - Country:US
Practice Address - Phone:617-524-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA606231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5104491Medicaid
MAAA143253OtherHARVARD PILGRIM HEALTHCARE
MA097372OtherTUFTS
MAAD0206OtherBLUE CROSS BLUE SHIELD
MAAD0206OtherBLUE CROSS BLUE SHIELD