Provider Demographics
NPI:1588417885
Name:MATTESON, SERENA JEANE
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:JEANE
Last Name:MATTESON
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 1:817 TEUTONIA DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1033
Mailing Address - Country:US
Mailing Address - Phone:262-716-6892
Mailing Address - Fax:
Practice Address - Street 1:23338 18TH ST
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9419
Practice Address - Country:US
Practice Address - Phone:262-960-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach