Provider Demographics
NPI:1508170606
Name:MATSON, ANDREA DAWN (BS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:MATSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 W MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-7652
Mailing Address - Country:US
Mailing Address - Phone:602-621-1293
Mailing Address - Fax:
Practice Address - Street 1:14435 N 7TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4371
Practice Address - Country:US
Practice Address - Phone:602-547-6996
Practice Address - Fax:602-457-6952
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA68432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant