Provider Demographics
NPI:1992433536
Name:MATTON, KRISTY CECILE
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:CECILE
Last Name:MATTON
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 1:181 IEYOUB RD
Mailing Address - Street 2:
Mailing Address - City:RAGLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70657-3016
Mailing Address - Country:US
Mailing Address - Phone:337-240-4062
Mailing Address - Fax:
Practice Address - Street 1:916 TOPSY RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5810
Practice Address - Country:US
Practice Address - Phone:337-217-4780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist