MEDICARE: DR. PATRICIA A MATESTIC PH.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
1	103TC2200X	Clinical Child & Adolescent Psychologist	PY60090956	WA

General Provider Information

NPI Number	:	1710211479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA A MATESTIC PH.D.

Provider Business Mailing Address
First Line	:	BLDG 690 BARNES BLVD
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438
Country	:	US
Telephone Number	:	253-982-1217
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 690 BARNES BLVD
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98438-7921
Country	:	US
Telephone Number	:	253-982-1217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	04/23/2025

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