Provider Demographics
NPI:1346474350
Name:MATHEW, DENNIS MAMMEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MAMMEN
Last Name:MATHEW
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9316 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73128-1839
Mailing Address - Country:US
Mailing Address - Phone:405-249-9646
Mailing Address - Fax:
Practice Address - Street 1:9316 SW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73128-1839
Practice Address - Country:US
Practice Address - Phone:405-249-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist