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NPI Code Detail

MEDICARE: DR. MATTHEW LOGAN WOSTER PSY.D.

MEDICARE: DR. MATTHEW LOGAN WOSTER PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist
2103TC0700XClinical PsychologistP.08381OH

General Provider Information

NPI Number : 1558926840
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW LOGAN WOSTER PSY.D.
Provider Business Mailing Address
First Line : 4750 N CLARENDON AVE APT 704
Second Line :
City : CHICAGO
State : IL
Zip : 60640-6622
Country : US
Telephone Number : 734-812-5189
Fax Number :
Provider Business Practice Location Address
First Line : 90 N SUMMIT ST
Second Line :
City : AKRON
State : OH
Zip : 44308-1951
Country : US
Telephone Number : 234-718-2331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2019
Last Update Date : 09/06/2022

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