Provider Demographics
NPI:1124464854
Name:HALVORSON, ANDREA JAYNE (MA, MT-BC, WMTR)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JAYNE
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:MA, MT-BC, WMTR
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:JAYNE
Other - Last Name:HATLELI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MT-BC
Mailing Address - Street 1:1537 HERITAGE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669-7312
Mailing Address - Country:US
Mailing Address - Phone:608-304-7294
Mailing Address - Fax:
Practice Address - Street 1:1537 HERITAGE BOULEVARD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669-5466
Practice Address - Country:US
Practice Address - Phone:608-304-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist