Provider Demographics
NPI:1386952208
Name:HENDRICKSON, ANDREANA MARELLA (SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREANA
Middle Name:MARELLA
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:ANDREANA
Other - Middle Name:MARELLA
Other - Last Name:SOMICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1929 E ROYALTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2868
Mailing Address - Country:US
Mailing Address - Phone:440-838-0990
Mailing Address - Fax:440-838-8440
Practice Address - Street 1:1929 E ROYALTON RD STE A
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2868
Practice Address - Country:US
Practice Address - Phone:440-838-0990
Practice Address - Fax:440-838-8440
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 10157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849916Medicaid