Provider Demographics
NPI:1518855014
Name:MATTINGLY, ZACHARY LEE (AUD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LEE
Last Name:MATTINGLY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 NORTHRIDGE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3314
Mailing Address - Country:US
Mailing Address - Phone:470-508-5343
Mailing Address - Fax:770-615-6091
Practice Address - Street 1:2944 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1409
Practice Address - Country:US
Practice Address - Phone:502-893-0159
Practice Address - Fax:770-615-6091
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002916A231H00000X
KY299542231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist