Provider Demographics
NPI:1811221286
Name:MATTA, LORI ALLISON (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ALLISON
Last Name:MATTA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ALLISON
Other - Last Name:REIGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:9264 SHARROTT RD
Mailing Address - Street 2:#103
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4501
Mailing Address - Country:US
Mailing Address - Phone:610-248-2886
Mailing Address - Fax:
Practice Address - Street 1:3135 WILMINGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1179
Practice Address - Country:US
Practice Address - Phone:724-598-0000
Practice Address - Fax:724-598-8000
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist