Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1953 | MT |
Y | 103T00000X | Psychologist | 1953 | MT |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6919 | OH |
NPI | 1073790416 |
---|---|
Provider Name | Dr. Michelle R Matzke |
First Address | Whitefish, MT 59937-3067 |
Second Address | Whitefish, MT 59937-3067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 13/04/2018 |