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General NPI Number Information
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NPI Number | 1477389583
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Entity Type | Individual
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Provider Name | EMILYRAE MATSKO
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Gender |
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1204 IL-164
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City | OQUAWKA
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State | IL
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Zip | 61469
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Country | US
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Telephone | 309-924-2414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 198
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City | OQUAWKA
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State | IL
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Zip | 61469-0198
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Country | US
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Telephone | 309-299-6674
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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