Provider Demographics
NPI:1215661004
Name:MATOSSIAN, TAMAR KEVORK (SLPA)
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:KEVORK
Last Name:MATOSSIAN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:TAMAR
Other - Middle Name:KEVORK
Other - Last Name:KARAKASHIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:820 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3336
Mailing Address - Country:US
Mailing Address - Phone:626-765-1724
Mailing Address - Fax:
Practice Address - Street 1:820 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3336
Practice Address - Country:US
Practice Address - Phone:626-765-1724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant