Healthcare Provider Details

I. General information

NPI: 1811574999
Provider Name (Legal Business Name): ANN KATHERINE MATZEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8361 WILMINGTON DR # 0
COLORADO SPRINGS CO
80920-7077
US

IV. Provider business mailing address

8361 WILMINGTON DR # 0
COLORADO SPRINGS CO
80920-7077
US

V. Phone/Fax

Practice location:
  • Phone: 719-244-7155
  • Fax:
Mailing address:
  • Phone: 719-244-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY.0005502
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: