Provider Demographics
NPI:1114471893
Name:MATEU, ALEXANDRA (SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MATEU
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ALEXANDRA
Other - Last Name:MATEU MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:16120 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3937
Mailing Address - Country:US
Mailing Address - Phone:425-747-4004
Mailing Address - Fax:
Practice Address - Street 1:16120 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3937
Practice Address - Country:US
Practice Address - Phone:425-747-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60631261235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist