Provider Demographics
NPI:1437668514
Name:MATTHEWS, KATIE GRIFFIN (SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:GRIFFIN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4401 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5200
Mailing Address - Country:US
Mailing Address - Phone:513-283-4754
Mailing Address - Fax:
Practice Address - Street 1:405 LOVE AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4403
Practice Address - Country:US
Practice Address - Phone:229-402-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16913235Z00000X
GASLP12379235Z00000X
MESP3823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty