Provider Demographics
NPI:1629864723
Name:WOOLEY, ANDREA SUE
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SUE
Last Name:WOOLEY
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 1:65 SW HIGHWAY JJ
Mailing Address - Street 2:
Mailing Address - City:LEETON
Mailing Address - State:MO
Mailing Address - Zip Code:64761-9193
Mailing Address - Country:US
Mailing Address - Phone:660-441-5594
Mailing Address - Fax:
Practice Address - Street 1:65 SW HIGHWAY JJ
Practice Address - Street 2:
Practice Address - City:LEETON
Practice Address - State:MO
Practice Address - Zip Code:64761-9193
Practice Address - Country:US
Practice Address - Phone:660-441-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251X00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251X00000XAgenciesSupports Brokerage