Healthcare Provider Details

I. General information

NPI: 1710211479
Provider Name (Legal Business Name): PATRICIA A MATESTIC PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 04/23/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 690 BARNES BLVD
TACOMA WA
98438-7921
US

IV. Provider business mailing address

BLDG 690 BARNES BLVD
MCCHORD AFB WA
98438
US

V. Phone/Fax

Practice location:
  • Phone: 253-982-1217
  • Fax:
Mailing address:
  • Phone: 253-982-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY60090956
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: