Provider Demographics
NPI:1790516557
Name:NILES, ANDREW L (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:NILES
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 ALA MOANA BLVD STE 1001
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5408
Mailing Address - Country:US
Mailing Address - Phone:808-469-4932
Mailing Address - Fax:808-447-3943
Practice Address - Street 1:677 ALA MOANA BLVD STE 625
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5415
Practice Address - Country:US
Practice Address - Phone:808-692-1580
Practice Address - Fax:808-447-3943
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-2329-0235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist