Healthcare Provider Details

I. General information

NPI: 1356771174
Provider Name (Legal Business Name): MATTHEW CUDDINGTON M.A., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 N ELM ST SUITE E
GREENSBORO NC
27455-2775
US

IV. Provider business mailing address

3816 N ELM ST SUITE E
GREENSBORO NC
27455-2775
US

V. Phone/Fax

Practice location:
  • Phone: 336-370-4070
  • Fax: 336-370-9008
Mailing address:
  • Phone: 336-370-4070
  • Fax: 336-370-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10050
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: