Provider Demographics
NPI:1437708401
Name:MATTHEWS, LAURYN (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12770 COIT RD STE 870
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1455
Mailing Address - Country:US
Mailing Address - Phone:972-756-0500
Mailing Address - Fax:972-756-0448
Practice Address - Street 1:12770 COIT RD STE 870
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1455
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:972-756-0448
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1997238106S00000X
TX406332355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician