Provider Demographics
NPI:1316754450
Name:HOLLOPETER, ANDREA LEE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:HOLLOPETER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 LONE PINE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5637
Mailing Address - Country:US
Mailing Address - Phone:541-613-3400
Mailing Address - Fax:458-226-2249
Practice Address - Street 1:3552 LONE PINE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5637
Practice Address - Country:US
Practice Address - Phone:541-613-3400
Practice Address - Fax:458-226-2249
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10250728106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician