Provider Demographics
NPI:1639687247
Name:MATROW, JANELLE LOUISE (SLP-A)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:LOUISE
Last Name:MATROW
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9518
Mailing Address - Country:US
Mailing Address - Phone:321-215-8617
Mailing Address - Fax:
Practice Address - Street 1:108A N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MA
Practice Address - Zip Code:01375-9502
Practice Address - Country:US
Practice Address - Phone:321-215-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1370OtherMASSACHUSETTS BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY