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General NPI Number Information
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NPI Number | 1689957680
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Entity Type | Individual
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Provider Name | KENDRA NOELLE MATTIX M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 225 VISTA SPRINGS CIR
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City | LEXINGTON
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State | SC
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Zip | 29072-8119
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Country | US
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Telephone | 803-359-3195
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Fax |
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Provider Business Mailing Address
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Address Line | 309 LONGBOW CT
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City | COLUMBIA
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State | SC
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Zip | 29212-0816
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Country | US
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Telephone | 803-530-9907
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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 | 4901
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License Number State | SC
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