Provider Demographics
NPI:1205156155
Name:MATTERN, BLAIR SCOTT (AUD)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:SCOTT
Last Name:MATTERN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BALL STATE UNIVERSITY
Mailing Address - Street 2:ARTS AND COMMUNICATION BLDG RM 104
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47306-0001
Mailing Address - Country:US
Mailing Address - Phone:765-285-5354
Mailing Address - Fax:765-285-5623
Practice Address - Street 1:BALL STATE UNIVERSITY
Practice Address - Street 2:ARTS AND COMMUNICATION BLDG RM 104
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47306-0001
Practice Address - Country:US
Practice Address - Phone:765-285-5354
Practice Address - Fax:765-285-5623
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA. 01732231H00000X
IN23002473A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist