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General NPI Number Information
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NPI Number | 1013712835
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Entity Type | Individual
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Provider Name | KELLY MATTHEWS
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Gender | Female
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 556 EAGLE ROCK AVE STE 105
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City | ROSELAND
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State | NJ
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Zip | 07068-1500
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Country | US
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Telephone | 973-763-2841
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Fax |
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Provider Business Mailing Address
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Address Line | 185 FOX HILL CT
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City | LAKE HOPATCONG
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State | NJ
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Zip | 07849-2442
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Country | US
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Telephone | 862-251-0418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS01295100
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License Number State | NJ
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