Provider Demographics
NPI:1881225324
Name:MATUTE, CAMILLE RENEE (MS)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:RENEE
Last Name:MATUTE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:RENEE
Other - Last Name:HEINRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 N EL MOLINO AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2675
Practice Address - Country:US
Practice Address - Phone:626-768-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist