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Individual
MATTHEW P PROVOST
Active
Individual
MATTHEW P PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS,CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP00739
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2058
SS NHPRC
RI
01
—
411302
SS BCHIP
RI
01
—
4600103
SS UHP
RI
05
—
9009994
—
RI
01
—
99947
SS BCROSS
RI
Enumeration date
07/10/2006
Last updated
07/30/2020
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