Provider Demographics
NPI:1457785040
Name:FIERRO, MATTHEW LOUIS (MS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LOUIS
Last Name:FIERRO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 HIDDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-4064
Mailing Address - Country:US
Mailing Address - Phone:315-303-5294
Mailing Address - Fax:
Practice Address - Street 1:716 E BELLA VISTA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3009
Practice Address - Country:US
Practice Address - Phone:863-683-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6296235Z00000X
FLSA13067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist