Provider Demographics
NPI:1417593153
Name:FALK, MATTHEW ALEX (AUD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALEX
Last Name:FALK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21613 JOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HARROLD
Mailing Address - State:SD
Mailing Address - Zip Code:57536-6907
Mailing Address - Country:US
Mailing Address - Phone:605-216-5775
Mailing Address - Fax:
Practice Address - Street 1:21613 JOE CREEK RD
Practice Address - Street 2:
Practice Address - City:HARROLD
Practice Address - State:SD
Practice Address - Zip Code:57536-6907
Practice Address - Country:US
Practice Address - Phone:605-216-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1036-A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist