Provider Demographics
NPI:1609691807
Name:MATSON, ALISA ELENOR (MS, SLP)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:ELENOR
Last Name:MATSON
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 AMERICAN RIVER DR STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5753
Mailing Address - Country:US
Mailing Address - Phone:213-453-4586
Mailing Address - Fax:
Practice Address - Street 1:3416 AMERICAN RIVER DR STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5753
Practice Address - Country:US
Practice Address - Phone:916-979-0497
Practice Address - Fax:916-972-9500
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist