Provider Demographics
NPI:1487852364
Name:MATTHEWS, JOSSENA B (MACCSLP)
Entity Type:Individual
Prefix:MS
First Name:JOSSENA
Middle Name:B
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MACCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 ARGYLL LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6758
Mailing Address - Country:US
Mailing Address - Phone:678-715-0544
Mailing Address - Fax:
Practice Address - Street 1:5355 ARGYLL LN
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6758
Practice Address - Country:US
Practice Address - Phone:678-715-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist