Provider Demographics
NPI:1336361518
Name:SELBST, ANDREA KUSHNER (MS)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:KUSHNER
Last Name:SELBST
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 RITTENHOUSE SQ APT 1702
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5838
Mailing Address - Country:US
Mailing Address - Phone:215-287-4191
Mailing Address - Fax:
Practice Address - Street 1:431 MORRIS RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5104
Practice Address - Country:US
Practice Address - Phone:215-816-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003174L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist