Provider Demographics
NPI:1093950826
Name:MATOLKA, MICHELLE DENISE (MS, CCC/L-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENISE
Last Name:MATOLKA
Suffix:
Gender:F
Credentials:MS, CCC/L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 E BROADWAY ST
Mailing Address - Street 2:# 122
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8597
Mailing Address - Country:US
Mailing Address - Phone:407-359-5693
Mailing Address - Fax:407-792-5693
Practice Address - Street 1:1809 E BROADWAY ST # 122
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8597
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist