Provider Demographics
NPI:1477844967
Name:SANDOVAL, MATTHEW ABELINO (SLPA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ABELINO
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6340 NEWT DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2047
Mailing Address - Country:US
Mailing Address - Phone:907-952-3361
Mailing Address - Fax:
Practice Address - Street 1:6340 NEWT DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2047
Practice Address - Country:US
Practice Address - Phone:907-952-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK302355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant