Healthcare Provider Details

I. General information

NPI: 1699632976
Provider Name (Legal Business Name): MICHELLE MATZKE THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 N KNOXVILLE AVE STE 203D
PEORIA IL
61614-3505
US

IV. Provider business mailing address

6035 N KNOXVILLE AVE STE 203D
PEORIA IL
61614-3505
US

V. Phone/Fax

Practice location:
  • Phone: 309-204-6547
  • Fax:
Mailing address:
  • Phone: 309-204-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE MATZKE
Title or Position: THERAPIST/OWNER
Credential: LCPC
Phone: 309-397-1233