Provider Demographics
NPI:1073790416
Name:MATZKE, MICHELLE R (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:R
Last Name:MATZKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-1200
Mailing Address - Country:US
Mailing Address - Phone:406-219-1477
Mailing Address - Fax:888-929-8661
Practice Address - Street 1:227 N BENT ST STE K
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2335
Practice Address - Country:US
Practice Address - Phone:406-219-1477
Practice Address - Fax:888-929-8661
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY750103T00000X
OH6919103TC2200X
MT1953103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent