Healthcare Provider Details

I. General information

NPI: 1497662878
Provider Name (Legal Business Name): ELIZABETH ANN MATTINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 HATCHERY RD
WATERFORD MI
48329-3140
US

IV. Provider business mailing address

501 N CASS LAKE RD
WATERFORD MI
48328-2307
US

V. Phone/Fax

Practice location:
  • Phone: 248-666-9593
  • Fax:
Mailing address:
  • Phone: 248-860-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801118368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: