Provider Demographics
NPI:1932336286
Name:GOTTLIEB, ANDREA (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 ANDREWS AVE APT C206
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-7260
Mailing Address - Country:US
Mailing Address - Phone:561-329-7434
Mailing Address - Fax:561-278-6468
Practice Address - Street 1:790 ANDREWS AVE APT C206
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-7260
Practice Address - Country:US
Practice Address - Phone:561-329-7434
Practice Address - Fax:561-278-6468
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist