Provider Demographics
NPI:1942892518
Name:MATVEYENKO, ALLA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:MATVEYENKO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 39TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-9114
Mailing Address - Country:US
Mailing Address - Phone:360-954-3215
Mailing Address - Fax:
Practice Address - Street 1:1201 39TH ST
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-9114
Practice Address - Country:US
Practice Address - Phone:360-954-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61115111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist