Provider Demographics
NPI:1396287421
Name:SMITH, ANDREA
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 CUYLER AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1118
Mailing Address - Country:US
Mailing Address - Phone:773-480-7275
Mailing Address - Fax:708-575-5807
Practice Address - Street 1:1211 CUYLER AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1118
Practice Address - Country:US
Practice Address - Phone:773-480-7275
Practice Address - Fax:708-575-5807
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist