Provider Demographics
NPI:1508241555
Name:MATSKO, LAUREN A (AUD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:MATSKO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 EDEN WAY NORTH
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2776
Mailing Address - Country:US
Mailing Address - Phone:757-547-3560
Mailing Address - Fax:757-547-5053
Practice Address - Street 1:703 THIMBLE SHOALS BLVD.
Practice Address - Street 2:SUITE C-3
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2576
Practice Address - Country:US
Practice Address - Phone:757-873-8794
Practice Address - Fax:757-873-5734
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA220100596231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2201001596OtherAUDIOLOGY LICENSE