Provider Demographics
NPI:1447662044
Name:MATUCH, ANN
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:MATUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 MALIBU DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7203
Mailing Address - Country:US
Mailing Address - Phone:440-885-8645
Mailing Address - Fax:440-842-9832
Practice Address - Street 1:7700 MALIBU DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-7203
Practice Address - Country:US
Practice Address - Phone:440-885-8645
Practice Address - Fax:440-842-9832
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist