Provider Demographics
NPI:1013712835
Name:MATTHEWS, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 FOX HILL CT
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-2442
Mailing Address - Country:US
Mailing Address - Phone:862-251-0418
Mailing Address - Fax:
Practice Address - Street 1:556 EAGLE ROCK AVE STE 105
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1500
Practice Address - Country:US
Practice Address - Phone:973-763-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01295100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist