MEDICARE: MR. DENNIS MAMMEN MATHEW MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3452	OK

General Provider Information

NPI Number	:	1346474350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS MAMMEN MATHEW MS CCC-SLP

Provider Business Mailing Address
First Line	:	9316 SW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-1839
Country	:	US
Telephone Number	:	405-249-9646
Fax Number	:

Provider Business Practice Location Address
First Line	:	9316 SW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-1839
Country	:	US
Telephone Number	:	405-249-9646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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Directions to “ MR. DENNIS MAMMEN MATHEW MS CCC-SLP” Practice Location

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