Provider Demographics
NPI:1558891333
Name:MATTIKO PEDIATRIC THERAPIES
Entity Type:Organization
Organization Name:MATTIKO PEDIATRIC THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:MATTIKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-903-9567
Mailing Address - Street 1:4130 LISBURN RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5980
Mailing Address - Country:US
Mailing Address - Phone:717-903-9567
Mailing Address - Fax:
Practice Address - Street 1:4130 LISBURN RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5980
Practice Address - Country:US
Practice Address - Phone:717-903-9567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006062L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty