Provider Demographics
NPI:1841832615
Name:ANDREA BANKS, SPEECH PATHOLOGY, LLC
Entity type:Organization
Organization Name:ANDREA BANKS, SPEECH PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:617-982-3025
Mailing Address - Street 1:11 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3007
Mailing Address - Country:US
Mailing Address - Phone:617-982-3025
Mailing Address - Fax:
Practice Address - Street 1:11 SALEM ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3007
Practice Address - Country:US
Practice Address - Phone:617-982-3025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech