Provider Demographics
NPI:1336970821
Name:SCHLIESSER, MATHEW SCOTT (SLP-CCC)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:SCOTT
Last Name:SCHLIESSER
Suffix:
Gender:M
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:SCOTT
Other - Last Name:SCHLIESSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12279 RESERVE MANOR CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-3759
Mailing Address - Country:US
Mailing Address - Phone:725-277-4125
Mailing Address - Fax:
Practice Address - Street 1:5200 ECOFF AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1615
Practice Address - Country:US
Practice Address - Phone:804-768-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist