Provider Demographics
NPI:1962640763
Name:MATTAS, MAUREEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MATTAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:SUITE S110
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2564
Mailing Address - Country:US
Mailing Address - Phone:402-327-2500
Mailing Address - Fax:402-327-2525
Practice Address - Street 1:8055 O ST
Practice Address - Street 2:SUITE S110
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2564
Practice Address - Country:US
Practice Address - Phone:402-327-2500
Practice Address - Fax:402-327-2525
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100250113-00Medicaid