Provider Demographics
NPI:1033954888
Name:GOTTESMAN, MATTHEW BRYAN (AUD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRYAN
Last Name:GOTTESMAN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 18TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-8630
Mailing Address - Country:US
Mailing Address - Phone:605-882-1591
Mailing Address - Fax:605-753-5591
Practice Address - Street 1:405 18TH AVE NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-8630
Practice Address - Country:US
Practice Address - Phone:605-882-1591
Practice Address - Fax:605-753-5591
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1145-A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist