Provider Demographics
NPI:1366080988
Name:SCHULTZ, MATTHEW EMERSON
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EMERSON
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 SE 28TH AVE APT 461
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-9403
Mailing Address - Country:US
Mailing Address - Phone:206-940-0641
Mailing Address - Fax:
Practice Address - Street 1:314 SW 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2802
Practice Address - Country:US
Practice Address - Phone:206-940-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker