Provider Demographics
NPI:1215134200
Name:HANCOCK, ANDREA AUSTIN (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:AUSTIN
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:MSCCCSLP
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 26106
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-1106
Mailing Address - Country:US
Mailing Address - Phone:864-905-9645
Mailing Address - Fax:
Practice Address - Street 1:509 N CARRIER ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1201
Practice Address - Country:US
Practice Address - Phone:270-389-3513
Practice Address - Fax:270-389-4706
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3169235Z00000X
SC5462235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist