Provider Demographics
NPI:1487970745
Name:MATSUMORI-KELLY, YURIKA (SP)
Entity type:Individual
Prefix:
First Name:YURIKA
Middle Name:
Last Name:MATSUMORI-KELLY
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:YURIKA
Other - Middle Name:
Other - Last Name:MATSUMORI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1076 KAMAOLE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2816
Mailing Address - Country:US
Mailing Address - Phone:808-722-3368
Mailing Address - Fax:
Practice Address - Street 1:1076 KAMAOLE ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-2816
Practice Address - Country:US
Practice Address - Phone:808-722-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISP-325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist