Provider Demographics
NPI:1679254320
Name:MATZEN, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MATZEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 OTTEN RD
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46065-9594
Mailing Address - Country:US
Mailing Address - Phone:765-413-3739
Mailing Address - Fax:
Practice Address - Street 1:701 ARMORY RD
Practice Address - Street 2:
Practice Address - City:DELPHI
Practice Address - State:IN
Practice Address - Zip Code:46923-1915
Practice Address - Country:US
Practice Address - Phone:765-564-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004105A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist