Provider Demographics
NPI:1225323991
Name:STUBBS, MATISA LEA (SLP)
Entity Type:Individual
Prefix:
First Name:MATISA
Middle Name:LEA
Last Name:STUBBS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S MAIN ST
Mailing Address - Street 2:STE 500
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3647
Mailing Address - Country:US
Mailing Address - Phone:901-312-5600
Mailing Address - Fax:
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:STE 500
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3647
Practice Address - Country:US
Practice Address - Phone:901-312-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist