Provider Demographics
NPI:1861683278
Name:SODERGREN, ANDREW J (PSYD, LP #6861)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:SODERGREN
Suffix:
Gender:M
Credentials:PSYD, LP #6861
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESSELMAN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1212
Mailing Address - Country:US
Mailing Address - Phone:513-407-8878
Mailing Address - Fax:513-417-8955
Practice Address - Street 1:6675 WESSELMAN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1212
Practice Address - Country:US
Practice Address - Phone:513-407-8878
Practice Address - Fax:513-407-8878
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical