Provider Demographics
NPI:1710921713
Name:CHRISTY, MATTHEW LYNN (AUD CCC-A)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LYNN
Last Name:CHRISTY
Suffix:
Gender:M
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S STATE ST
Mailing Address - Street 2:SUITE R-6
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6774
Mailing Address - Country:US
Mailing Address - Phone:734-663-2915
Mailing Address - Fax:734-663-2965
Practice Address - Street 1:2900 S STATE ST
Practice Address - Street 2:SUITE R-6
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6774
Practice Address - Country:US
Practice Address - Phone:734-663-2915
Practice Address - Fax:734-663-2965
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000058231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710921713Medicaid
MI1710921713Medicaid