Provider Demographics
NPI:1598511305
Name:MATVEEV, KASSANDRA MARJORIE (CBT/RBT)
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:MARJORIE
Last Name:MATVEEV
Suffix:
Gender:
Credentials:CBT/RBT
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:MARJORIE
Other - Last Name:MALMSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:823 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-3413
Mailing Address - Country:US
Mailing Address - Phone:509-904-5775
Mailing Address - Fax:
Practice Address - Street 1:707 W 7TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2833
Practice Address - Country:US
Practice Address - Phone:509-850-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-22-236444106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician