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General NPI Number Information
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NPI Number | 1558926840
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Entity Type | Individual
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Provider Name | MATTHEW LOGAN WOSTER PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 90 N SUMMIT ST
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City | AKRON
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State | OH
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Zip | 44308-1951
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Country | US
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Telephone | 234-718-2331
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 N CLARENDON AVE APT 704
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City | CHICAGO
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State | IL
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Zip | 60640-6622
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Country | US
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Telephone | 734-812-5189
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.08381
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License Number State | OH
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