Healthcare Provider Details

I. General information

NPI: 1427962398
Provider Name (Legal Business Name): BRONWYN CHRISTINE MATOSKI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WALL ST
VALPARAISO IN
46383-2537
US

IV. Provider business mailing address

501 WALL ST
VALPARAISO IN
46383-2537
US

V. Phone/Fax

Practice location:
  • Phone: 219-364-0392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828826
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: