Provider Demographics
NPI:1285706085
Name:ANDREW, KRISTINE E (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:E
Last Name:ANDREW
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ANDREW
Other - Last Name:GOTHBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3445 POST ROAD
Mailing Address - Street 2:J ARTHUR TRUDEAU MEMORIAL CENTER ATTN KIM RUELLE HR
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7147
Mailing Address - Country:US
Mailing Address - Phone:401-739-2700
Mailing Address - Fax:401-737-8907
Practice Address - Street 1:3445 POST ROAD
Practice Address - Street 2:J ARTHUR TRUDEAU MEMORIAL CENTER ATTN KIM RUELLE HR
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7147
Practice Address - Country:US
Practice Address - Phone:401-739-2700
Practice Address - Fax:401-737-8907
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0177OtherNEIGHBORHOOD HEALTH
RIKC02260Medicaid
RI4224OtherNEIGHBORHOOD HEALTH
RI294096OtherBCBS
RI4600113OtherUNITED HEALTHCARE
RI412372OtherBLUE CHIP