Provider Demographics
NPI:1932336773
Name:NEWELL, ANDREA L (SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:NEWELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:NORTH COAST THERAPY LLC
Mailing Address - City:WADDINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:13694-0249
Mailing Address - Country:US
Mailing Address - Phone:315-388-7703
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WADDINGTON
Practice Address - State:NY
Practice Address - Zip Code:13694-0249
Practice Address - Country:US
Practice Address - Phone:315-388-7703
Practice Address - Fax:315-388-4707
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist