Matthew Fornes, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12303 Issued in NC

Practice address

200 Trade St
Tarboro, NC 27886-5055

Phone

(252) 823-2799

NPI assigned

Jul 17, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Healthcare Services, Inc.

  • Physical Therapist
  • Durham, NC
  • NPI 1104823400

  Speech-Language Pathologist

  Medicare reassignment NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Speech-Language Pathologist

  NPD

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

{
    "created_epoch": "1721174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1407694151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 CROWN POINT RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TRADE ST",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278865055",
            "telephone_number": "252-823-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNES",
        "first_name": "MATTHEW",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NC",
            "license": "12303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family & Community Resources, Inc
• Ashley Lauren Feeley, FNP-BC
• First Class Transit Inc
• Shaun Fitzpatrick, FNP
• FMS Ena Home, LLC
• Meaghan Foster
• Fountain Adult Home Care, LLC
• Fountain Transportation
• Lavone Freeman
• Paula Elizabeth Fulford, PT, DPT

• Speech-Language Pathologist in Tarboro, NC
• Providers in Tarboro, NC by specialty
• Speech-Language Pathologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.