Healthcare Provider Details

I. General information

NPI: 1073938767
Provider Name (Legal Business Name): CALVIN PAUL MATSON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4234
US

IV. Provider business mailing address

72 SHELDON BLVD. SE
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-742-0351
  • Fax:
Mailing address:
  • Phone: 616-742-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093607
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: