Provider Demographics
NPI:1073091450
Name:MATTHEWS, BROOKE ASHTEN
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:ASHTEN
Last Name:MATTHEWS
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 1:1 HALLORAN PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1367
Mailing Address - Country:US
Mailing Address - Phone:740-296-5743
Mailing Address - Fax:740-296-5952
Practice Address - Street 1:1 HALLORAN PARK LN
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1367
Practice Address - Country:US
Practice Address - Phone:740-296-5743
Practice Address - Fax:740-296-5952
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician