Provider Demographics
NPI:1912330234
Name:MATTHEWS, SHANA BATES (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:BATES
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 HALL STATION DR
Mailing Address - Street 2:UNITE 200
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-6013
Mailing Address - Country:US
Mailing Address - Phone:757-334-7207
Mailing Address - Fax:
Practice Address - Street 1:902 HALL STATION DR
Practice Address - Street 2:UNITE 200
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-6013
Practice Address - Country:US
Practice Address - Phone:757-334-7207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-11
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist