Provider Demographics
NPI:1699979104
Name:DERUITER, ANDREA L (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:DERUITER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:DERUITER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-0502
Practice Address - Fax:206-598-0516
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist