Healthcare Provider Details

I. General information

NPI: 1700602687
Provider Name (Legal Business Name): MATTHEW ALDEN STEBBINS CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N 3RD ST
COEUR D ALENE ID
83814-3400
US

IV. Provider business mailing address

1801 N 3RD ST STE 200
COEUR D ALENE ID
83814-3400
US

V. Phone/Fax

Practice location:
  • Phone: 208-261-1158
  • Fax:
Mailing address:
  • Phone: 208-261-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: