Provider Demographics
NPI:1194962811
Name:MCELROY, ANDREA D (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:MCELROY
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 1:817 N. MOUND ST.
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4427
Mailing Address - Country:US
Mailing Address - Phone:936-564-6907
Mailing Address - Fax:936-564-0509
Practice Address - Street 1:817 N. MOUND ST.
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4427
Practice Address - Country:US
Practice Address - Phone:936-564-6907
Practice Address - Fax:936-564-0509
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201338501Medicaid