Individual
COREY POE MATTORANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS. CCC-SLP
Contact information
Practice address
704 FORTINO BLVD STE A, PUEBLO, CO 81008-2087
(719) 305-8300
Mailing address
1129 E DESERT COVE DR, PUEBLO WEST, CO 81007-6521
(505) 358-0623
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
C-6059
NM
235Z00000X
Speech-Language Pathologist
Primary
SLP.0003056
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000162889
—
CO
Enumeration date
09/14/2016
Last updated
11/20/2018
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