Provider Demographics
NPI:1356023014
Name:NAZARENO, ANDREA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NAZARENO
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 1:940 W INDIAN SCHOOL RD APT 89
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3165
Mailing Address - Country:US
Mailing Address - Phone:480-694-2961
Mailing Address - Fax:
Practice Address - Street 1:2013 N 36TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-3098
Practice Address - Country:US
Practice Address - Phone:602-381-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA143612355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant