Provider Demographics
NPI:1831840271
Name:DANA SURENA MATTSON, SLP, COM, LLC
Entity type:Organization
Organization Name:DANA SURENA MATTSON, SLP, COM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SURENA-MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP, COM, LLC
Authorized Official - Phone:203-966-7225
Mailing Address - Street 1:11 FOREST ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4745
Mailing Address - Country:US
Mailing Address - Phone:203-966-7225
Mailing Address - Fax:203-920-1402
Practice Address - Street 1:11 FOREST ST STE 203
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4745
Practice Address - Country:US
Practice Address - Phone:203-966-7225
Practice Address - Fax:203-920-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty