MEDICARE: MATTHEW CLEM PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1225560055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CLEM PHD

Provider Business Mailing Address
First Line	:	11882 GREENVILLE AVE
Second Line	:	STE 107
City	:	DALLAS
State	:	TX
Zip	:	75243-3567
Country	:	US
Telephone Number	:	972-644-8686
Fax Number	:	972-644-8688

Provider Business Practice Location Address
First Line	:	6363 FOREST PARK RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-5479
Country	:	US
Telephone Number	:	214-648-4316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	09/05/2019

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