Provider Demographics
NPI:1891951000
Name:MATTES, NANCY A (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:A
Last Name:MATTES
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13045 S 83RD CT
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2144
Mailing Address - Country:US
Mailing Address - Phone:708-361-3984
Mailing Address - Fax:
Practice Address - Street 1:13045 S 83RD CT
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2144
Practice Address - Country:US
Practice Address - Phone:708-361-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003009235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist