Provider Demographics
NPI:1841692209
Name:MATTHEWS, CAROL LYNN (SLP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-9456
Mailing Address - Country:US
Mailing Address - Phone:260-376-2286
Mailing Address - Fax:
Practice Address - Street 1:611 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9456
Practice Address - Country:US
Practice Address - Phone:260-376-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA508678J235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist