Healthcare Provider Details

I. General information

NPI: 1205747961
Provider Name (Legal Business Name): ERIS MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 N US HIGHWAY 89
FLAGSTAFF AZ
86004-2837
US

IV. Provider business mailing address

5130 N US HIGHWAY 89
FLAGSTAFF AZ
86004-2837
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP17826
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: