Provider Demographics
NPI:1467076877
Name:MATTIS, ALAINA (MS CF-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:MATTIS
Suffix:
Gender:F
Credentials:MS CF-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-7025
Mailing Address - Country:US
Mailing Address - Phone:516-993-3183
Mailing Address - Fax:
Practice Address - Street 1:150-50 14TH RD
Practice Address - Street 2:
Practice Address - City:WHITESTEONE
Practice Address - State:NY
Practice Address - Zip Code:11357
Practice Address - Country:US
Practice Address - Phone:516-993-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist