Provider Demographics
NPI:1659533891
Name:BAUD, MATTHEW R (CCC-SLPL)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:BAUD
Suffix:
Gender:M
Credentials:CCC-SLPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 STAR CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8704
Mailing Address - Country:US
Mailing Address - Phone:708-935-5188
Mailing Address - Fax:
Practice Address - Street 1:9255 STAR CT
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-8704
Practice Address - Country:US
Practice Address - Phone:708-935-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist