Itzel C Matamoros Santos, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL61483039 Issued in WA

Practice address

19215 SE 34TH St # 106-220
Camas, WA 98607-8829

Phone

(414) 369-0137

NPI assigned

Oct 31, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1225801384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19215 SE 34TH ST # 106-220",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986078829",
            "telephone_number": "414-369-0137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19215 SE 34TH ST # 106-220",
            "city": "CAMAS",
            "state": "WA",
            "postal_code": "986078829",
            "telephone_number": "414-369-0137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATAMOROS SANTOS",
        "first_name": "ITZEL",
        "middle_name": "C",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-31",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IN",
            "license": "22008923A",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL61483039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaila Kona-Nicole Mann, PT, DPT
• Melissa E Marquardt, MS, RD
• Teresa Marquez
• Savannah Simona Martinez, D.C.
• Mary Annable Mason, LMP
• Lori Ann Maupin, D.C.
• Galen Maze-Rothstein, M.D.
• Sarah Cassandra McClaran, M.S.
• Christina Francesca McCoy, LMT
• Julie McDonald, LMHC

• Speech-Language Pathologist in Camas, WA
• Providers in Camas, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.