Provider Demographics
NPI:1437303534
Name:MATHEWS, KIRSHINA R (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KIRSHINA
Middle Name:R
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 RUFFIN GREEN CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8773
Mailing Address - Country:US
Mailing Address - Phone:409-457-7443
Mailing Address - Fax:281-416-1799
Practice Address - Street 1:3211 RUFFIN GREEN CT
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8773
Practice Address - Country:US
Practice Address - Phone:409-457-7443
Practice Address - Fax:281-416-1799
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist