Provider Demographics
NPI:1447506829
Name:MATZ, PATRICIA (SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:MATZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MATZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:2012 IRONWOOD CIRCLE
Mailing Address - Street 2:230
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635
Mailing Address - Country:US
Mailing Address - Phone:574-387-4049
Mailing Address - Fax:574-387-4062
Practice Address - Street 1:2012 IRONWOOD CIR
Practice Address - Street 2:230
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1888
Practice Address - Country:US
Practice Address - Phone:574-387-4049
Practice Address - Fax:574-387-4062
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22000756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist