Provider Demographics
NPI:1063572196
Name:MATTKE, AMANDA MONEE (PSYS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MONEE
Last Name:MATTKE
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E COLGATE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1839
Mailing Address - Country:US
Mailing Address - Phone:480-897-6202
Mailing Address - Fax:480-777-0146
Practice Address - Street 1:8409 S AVENIDA DEL YAQUI
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1027
Practice Address - Country:US
Practice Address - Phone:480-987-6202
Practice Address - Fax:480-777-0146
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist