Doctor Name: | COLLEEN ELIZABETH MATTESON |
NPI Number: | 1336379320 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 146.009893 |
Business Practice Address: | 3411 Avondale Ln New Lenox, IL - 604518602 |
Business Phone Number: | 7083086859 |
Business Fax Number: | |
Mailing Address: | 3411 Avondale Ln, NEW LENOX |
State: | IL |
Postal Code: | 604518602 |
Phone Number: | 7083086859 |
Fax Number: | |
NPI Enumeration Date: | 07/23/2009 |
NPI Last Update Date: | 09/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 146.009893 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |