Provider Demographics
NPI:1689830416
Name:MATTHIAS, LA-TANYA ROWE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:LA-TANYA
Middle Name:ROWE
Last Name:MATTHIAS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:LA-TANYA
Other - Middle Name:PATRICE
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:2320 OAKTON PL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5255
Mailing Address - Country:US
Mailing Address - Phone:954-609-0802
Mailing Address - Fax:
Practice Address - Street 1:2385 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3168
Practice Address - Country:US
Practice Address - Phone:404-289-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008466235Z00000X
FLSA9373235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist