Provider Demographics
NPI:1710993993
Name:MICHAELS, MATTHEW D (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5605
Mailing Address - Country:US
Mailing Address - Phone:310-829-6444
Mailing Address - Fax:818-368-6061
Practice Address - Street 1:1318 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1118
Practice Address - Country:US
Practice Address - Phone:310-393-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1730237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0017300Medicaid
CAAU1730OtherLICENSE NO
CAAU0017300Medicaid