Provider Demographics
NPI:1801633110
Name:MATHEWS, KAMERON (SLP)
Entity type:Individual
Prefix:
First Name:KAMERON
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22505 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:OK
Mailing Address - Zip Code:74445-2860
Mailing Address - Country:US
Mailing Address - Phone:918-752-6636
Mailing Address - Fax:
Practice Address - Street 1:206 S GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-4600
Practice Address - Country:US
Practice Address - Phone:918-931-3888
Practice Address - Fax:918-931-3887
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist