Provider Demographics
NPI:1609179985
Name:SMITH, MATTHEW WF (MBA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WF
Last Name:SMITH
Suffix:
Gender:M
Credentials:MBA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE E-15
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-872-4327
Mailing Address - Fax:505-872-1041
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE E-15
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-872-4327
Practice Address - Fax:505-872-1041
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4844237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter