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General NPI Number Information
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NPI Number | 1073790416
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Entity Type | Individual
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Provider Name | MICHELLE R MATZKE PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 227 N BENT ST STE K
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City | POWELL
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State | WY
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Zip | 82435-2335
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Country | US
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Telephone | 406-219-1477
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Fax | 888-929-8661
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Provider Business Mailing Address
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Address Line | PO BOX 1200
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City | POWELL
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State | WY
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Zip | 82435-1200
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Country | US
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Telephone | 406-219-1477
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Fax | 888-929-8661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 750
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 6919
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1953
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License Number State | MT
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