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General NPI Number Information
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NPI Number | 1154848661
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Entity Type | Individual
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Provider Name | STACY MARIE MATE
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Gender | Female
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 111 W GRAND VALLEY AVE
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City | ORWELL
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State | OH
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Zip | 44076-9437
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Country | US
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Telephone | 440-805-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 1689 CHAPEL RD
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City | JEFFERSON
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State | OH
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Zip | 44047-8716
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Country | US
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Telephone | 440-994-9196
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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 | COND.2017342-SP
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP.13113
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License Number State | OH
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