Provider Demographics
NPI:1144494253
Name:VANBUREN, ANDREA MARIE (SLP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-6409
Mailing Address - Country:US
Mailing Address - Phone:318-691-0898
Mailing Address - Fax:
Practice Address - Street 1:818 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6409
Practice Address - Country:US
Practice Address - Phone:318-691-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1720208Medicaid