Provider Demographics
NPI:1497942247
Name:MATHEWS, MELISSA C (MA, CCC-SLP, ATP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MA, CCC-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S INTERSTATE 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7420
Mailing Address - Country:US
Mailing Address - Phone:512-414-1700
Mailing Address - Fax:
Practice Address - Street 1:2100 WESTFALIAN TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1967
Practice Address - Country:US
Practice Address - Phone:512-587-5671
Practice Address - Fax:512-535-6786
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist