Provider Demographics
NPI:1043465073
Name:MATTHEWS, MISTY ELLER (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:ELLER
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:KAY
Other - Last Name:ELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 WINDING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8855
Mailing Address - Country:US
Mailing Address - Phone:828-779-4582
Mailing Address - Fax:
Practice Address - Street 1:25 WINDING HILLS DR
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8855
Practice Address - Country:US
Practice Address - Phone:828-779-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist