Healthcare Provider Details

I. General information

NPI: 1992641104
Provider Name (Legal Business Name): COLLEEN JUNE MATTHYS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E FOREST ST
OCONOMOWOC WI
53066-3707
US

IV. Provider business mailing address

1608 WAKEFIELD CT
MUNDELEIN IL
60060-3375
US

V. Phone/Fax

Practice location:
  • Phone: 224-220-4896
  • Fax:
Mailing address:
  • Phone: 224-220-4896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: