Healthcare Provider Details

I. General information

NPI: 1215227129
Provider Name (Legal Business Name): ANTHONY ALAN MATSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EASTERN AVE SE
GRAND RAPIDS MI
49503-4735
US

IV. Provider business mailing address

330 EASTERN AVE SE
GRAND RAPIDS MI
49503-4737
US

V. Phone/Fax

Practice location:
  • Phone: 616-776-0891
  • Fax: 616-233-0718
Mailing address:
  • Phone: 616-776-0891
  • Fax: 616-233-0718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: