Provider Demographics
NPI:1619114725
Name:KIRKMAN, ANDREA
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:KIRKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:KIRKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:7744 LYNNLE WAY
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-1778
Mailing Address - Country:US
Mailing Address - Phone:423-987-0318
Mailing Address - Fax:
Practice Address - Street 1:7744 LYNNLE WAY
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-1778
Practice Address - Country:US
Practice Address - Phone:423-987-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000001843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist