Individual
ALEXANDRA MATISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC SLP
Contact information
Practice address
822 MONTGOMERY AVE STE 306, NARBERTH, PA 19072-1948
(215) 220-2210
Mailing address
822 MONTGOMERY AVE STE 306, NARBERTH, PA 19072-1948
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL014087
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
QCH126565423001
INDEPENDENCE KEYSTONE
—
Enumeration date
08/16/2018
Last updated
08/16/2018
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