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NPI Code Detail

MEDICARE: MATTHEW P PROVOST MS,CCC-SLP

MEDICARE: MATTHEW P PROVOST 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
1235Z00000XSpeech-Language PathologistSP00739RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14600103OTHERRISS UHP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3411302OTHERRISS BCHIP
42058OTHERRISS NHPRC
599947OTHERRISS BCROSS

General Provider Information

NPI Number : 1962436519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW P PROVOST MS,CCC-SLP
Provider Business Mailing Address
First Line : 161 COMSTOCK PKWY
Second Line :
City : CRANSTON
State : RI
Zip : 02921-2002
Country : US
Telephone Number : 401-463-0202
Fax Number :
Provider Business Practice Location Address
First Line : 161 COMSTOCK PKWY
Second Line :
City : CRANSTON
State : RI
Zip : 02921-2002
Country : US
Telephone Number : 401-463-0202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 07/30/2020

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Directions to “ MATTHEW P PROVOST MS,CCC-SLP” Practice Location

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