Provider Demographics
NPI:1760900427
Name:MATOS, ERIN R (BS, MS, CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:R
Last Name:MATOS
Suffix:
Gender:F
Credentials:BS, MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 CELEBRATION PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3267
Mailing Address - Country:US
Mailing Address - Phone:618-920-3349
Mailing Address - Fax:
Practice Address - Street 1:118 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1419
Practice Address - Country:US
Practice Address - Phone:618-632-3666
Practice Address - Fax:618-632-7864
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist