Provider Demographics
NPI:1467685867
Name:BAKKE, MATTHEW HANS SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HANS
Last Name:BAKKE
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7905 BELGARO RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1108
Mailing Address - Country:US
Mailing Address - Phone:301-725-5324
Mailing Address - Fax:
Practice Address - Street 1:800 FLORIDA AVE NE
Practice Address - Street 2:SLCC 3114
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3600
Practice Address - Country:US
Practice Address - Phone:202-651-5335
Practice Address - Fax:202-448-7144
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001136231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist