Basic Information
| Provider Information | |||||||||
| NPI: | 1114158912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTELS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1525 RIDGEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486426425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898356333 | ||||||||
| FaxNumber: | 9898354920 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 RIDGEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486426425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898356333 | ||||||||
| FaxNumber: | 9898354920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2009 | ||||||||
| LastUpdateDate: | 07/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | E1747811 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.