MEDICARE: ERIN TAYLOR MATLOSZ PSY.D.

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	103K00000X	Behavior Analyst	1-14-15547	MI
2	103TC0700X	Clinical Psychologist	6301015312	MI

General Provider Information

NPI Number	:	1548537566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN TAYLOR MATLOSZ PSY.D.

Provider Business Mailing Address
First Line	:	3292 EVERGREEN DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9580
Country	:	US
Telephone Number	:	616-365-8920
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 CHICAGO DR SW STE 304
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1694
Country	:	US
Telephone Number	:	616-260-7915
Fax Number	:	616-333-5394

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

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	03/12/2024

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