Provider Demographics
NPI:1891575742
Name:KINSLOW, MATTHEW GANIM (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GANIM
Last Name:KINSLOW
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WEDGE ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-1720
Mailing Address - Country:US
Mailing Address - Phone:571-419-3888
Mailing Address - Fax:
Practice Address - Street 1:49 FARNUM PIKE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-3211
Practice Address - Country:US
Practice Address - Phone:401-949-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist