Provider Demographics
NPI:1730787102
Name:MATHENY, SAMUEL AARON
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:AARON
Last Name:MATHENY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MARKET ST STE 70
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2395
Mailing Address - Country:US
Mailing Address - Phone:541-258-6166
Mailing Address - Fax:541-258-6166
Practice Address - Street 1:90 MARKET ST STE 70
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2395
Practice Address - Country:US
Practice Address - Phone:541-258-6166
Practice Address - Fax:541-258-6166
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10156733237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist