Provider Demographics
NPI:1912332677
Name:MATTHYS, OLIVIA ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANN
Last Name:MATTHYS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7534
Mailing Address - Country:US
Mailing Address - Phone:952-224-0707
Mailing Address - Fax:952-224-1612
Practice Address - Street 1:1014 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7534
Practice Address - Country:US
Practice Address - Phone:952-224-0707
Practice Address - Fax:952-224-1612
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist