Healthcare Provider Details

I. General information

NPI: 1295668549
Provider Name (Legal Business Name): CHLOE MATUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 S BRIDGEWAY PL STE 150
EAGLE ID
83616-6953
US

IV. Provider business mailing address

738 S BRIDGEWAY PL STE 150
EAGLE ID
83616-6953
US

V. Phone/Fax

Practice location:
  • Phone: 888-392-8642
  • Fax:
Mailing address:
  • Phone: 888-392-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25-499793
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: