Provider Demographics
NPI:1851359087
Name:MATOS-PEREZ, MAUREEN (MA CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:MATOS-PEREZ
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:MISS
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:MATOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7081 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4223
Mailing Address - Country:US
Mailing Address - Phone:937-476-7186
Mailing Address - Fax:
Practice Address - Street 1:7081 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-476-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01680237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2367282Medicaid
OH2955628Medicaid
OH366719Medicare PIN