Healthcare Provider Details

I. General information

NPI: 1578785796
Provider Name (Legal Business Name): LISA ANNE MATYS M,S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9641 W 153RD ST STE 46
ORLAND PARK IL
60462-3777
US

IV. Provider business mailing address

7403 162ND PL
TINLEY PARK IL
60477-1542
US

V. Phone/Fax

Practice location:
  • Phone: 708-822-6680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146008484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: