Healthcare Provider Details

I. General information

NPI: 1366467565
Provider Name (Legal Business Name): SANDRA MATTHES M.A. PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 PENNSYLVANIA AVE
KANSAS CITY MO
64112-2346
US

IV. Provider business mailing address

4929 PENNSYLVANIA AVE
KANSAS CITY MO
64112-2346
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-2396
  • Fax:
Mailing address:
  • Phone: 816-753-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00762
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: