Provider Demographics
NPI:1104261676
Name:MCDERMET, ANDREA MARIE (CSLP-A)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:MCDERMET
Suffix:
Gender:F
Credentials:CSLP-A
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLPA
Mailing Address - Street 1:4545 N 36TH ST
Mailing Address - Street 2:125A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3462
Mailing Address - Country:US
Mailing Address - Phone:602-224-0202
Mailing Address - Fax:
Practice Address - Street 1:4545 N 36TH ST
Practice Address - Street 2:125A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3462
Practice Address - Country:US
Practice Address - Phone:602-224-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA77242355S0801X
AZSLPA155522355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant