Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801079844 | MI |
NPI | 1003069907 |
---|---|
Provider Name | Mr. Kirk W Matthews |
First Address | Marquette, MI 49855-4630 |
Second Address | Marquette, MI 49855-2675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 01/05/2020 |