Healthcare Provider Details

I. General information

NPI: 1295788230
Provider Name (Legal Business Name): STACEY MATSON AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD VAMC PHOENIX AUDIOLOGY (126)
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

650 E INDIAN SCHOOL RD VAMC PHOENIX AUDIOLOGY (126)
PHOENIX AZ
85012-1839
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-6412
  • Fax:
Mailing address:
  • Phone: 602-222-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA1566
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: