Provider Demographics
NPI:1922848845
Name:MATZDORF, KATHRYN (AUD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MATZDORF
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MATZDORF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:4306 N QUINLAN PARK RD APT 1307
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-6042
Mailing Address - Country:US
Mailing Address - Phone:301-247-7497
Mailing Address - Fax:
Practice Address - Street 1:6611 RIVER PLACE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1162
Practice Address - Country:US
Practice Address - Phone:512-677-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81620231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist