Doctor Name: | MRS. MICHELLE DENISE MATOLKA |
NPI Number: | 1093950826 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC/L-SLP |
License Number: | SA13884 |
Business Practice Address: | 1809 E Broadway St # 122 Oviedo, FL - 327658597 |
Business Phone Number: | 4073595693 |
Business Fax Number: | |
Mailing Address: | 1809 E Broadway St, # 122 OVIEDO |
State: | FL |
Postal Code: | 327658597 |
Phone Number: | 4073595693 |
Fax Number: | 4077925693 |
NPI Enumeration Date: | 12/08/2008 |
NPI Last Update Date: | 01/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA13884 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |