Provider Demographics
NPI:1033450838
Name:JECKER, MATTHEW A
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:JECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 LANGDON DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5006
Mailing Address - Country:US
Mailing Address - Phone:937-572-3333
Mailing Address - Fax:
Practice Address - Street 1:6119 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-1925
Practice Address - Country:US
Practice Address - Phone:937-572-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3143237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist