Healthcare Provider Details

I. General information

NPI: 1073376935
Provider Name (Legal Business Name): WENDY KAY MATZKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N OCOTILLO DR
APACHE JUNCTION AZ
85120-5323
US

IV. Provider business mailing address

310 N OCOTILLO DR
APACHE JUNCTION AZ
85120-5323
US

V. Phone/Fax

Practice location:
  • Phone: 702-742-4047
  • Fax:
Mailing address:
  • Phone: 702-742-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00383560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: