Provider Demographics
NPI:1174071377
Name:MATTER, LAUREN LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:LEIGH
Last Name:MATTER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 EVELINE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1708
Mailing Address - Country:US
Mailing Address - Phone:570-906-1251
Mailing Address - Fax:
Practice Address - Street 1:3671 EVELINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1708
Practice Address - Country:US
Practice Address - Phone:570-906-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist