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General NPI Number Information
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NPI Number | 1083018311
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Entity Type | Individual
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Provider Name | MATTHEW ALLEN TEDRICK M.A.-SLP
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Gender | Male
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 445 BLOSSOM CIR
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City | TALLMADGE
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State | OH
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Zip | 44278-2975
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Country | US
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Telephone | 330-962-0294
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Fax |
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Provider Business Mailing Address
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Address Line | 445 BLOSSOM CIR
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City | TALLMADGE
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State | OH
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Zip | 44278-2975
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Country | US
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Telephone | 330-962-0294
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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 | SP. 11470
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License Number State | OH
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