MEDICARE: LA-TANYA ROWE MATTHIAS MS,CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP008466	GA
2	235Z00000X	Speech-Language Pathologist	SA9373	FL

General Provider Information

NPI Number	:	1689830416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA-TANYA ROWE MATTHIAS MS,CCC-SLP

Provider Business Mailing Address
First Line	:	2320 OAKTON PL SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-5255
Country	:	US
Telephone Number	:	954-609-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	2385 LAWRENCEVILLE HWY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3168
Country	:	US
Telephone Number	:	404-289-4270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	04/29/2018

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