Provider Demographics
NPI:1568950459
Name:WETMORE, MATTHEW (AUD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:WETMORE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8877 W UNION HILLS DR STE 350
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3026
Mailing Address - Country:US
Mailing Address - Phone:623-428-0727
Mailing Address - Fax:
Practice Address - Street 1:15015 W BELL RD STE 101
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3248
Practice Address - Country:US
Practice Address - Phone:623-227-1924
Practice Address - Fax:623-738-3913
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA10639231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist