Provider Demographics
NPI:1063285310
Name:MATHEWS, ANGELIQUE N
Entity type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:N
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20409 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4079
Mailing Address - Country:US
Mailing Address - Phone:313-434-9688
Mailing Address - Fax:
Practice Address - Street 1:19800 HALL RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5318
Practice Address - Country:US
Practice Address - Phone:855-996-2264
Practice Address - Fax:586-948-0223
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator