Provider Demographics
NPI:1366681140
Name:MARURE, MATTHEW MOSES
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MOSES
Last Name:MARURE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WARD PKWY APT 906
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2120
Mailing Address - Country:US
Mailing Address - Phone:443-243-5801
Mailing Address - Fax:
Practice Address - Street 1:17100 E SHEA BLVD STE 225
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6744
Practice Address - Country:US
Practice Address - Phone:480-837-4565
Practice Address - Fax:888-957-8277
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP9365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist