Provider Demographics
NPI:1073358107
Name:RANDAL, MATTHEW (AUD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:RANDAL
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 N LAMAR BLVD APT 6107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2381
Mailing Address - Country:US
Mailing Address - Phone:303-525-0529
Mailing Address - Fax:
Practice Address - Street 1:4106 MARATHON BLVD STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3746
Practice Address - Country:US
Practice Address - Phone:512-407-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81611231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist