Provider Demographics
NPI:1699516336
Name:MATZEDER, CHRISTENA
Entity type:Individual
Prefix:
First Name:CHRISTENA
Middle Name:
Last Name:MATZEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 W STONE MNR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8210
Mailing Address - Country:US
Mailing Address - Phone:870-350-0744
Mailing Address - Fax:
Practice Address - Street 1:916 GOBLIN DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-8885
Practice Address - Country:US
Practice Address - Phone:870-654-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2027302355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant