Provider Demographics
NPI:1982966412
Name:KRESSIN, MATTHEW W (PSYD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:W
Last Name:KRESSIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-8020
Mailing Address - Country:US
Mailing Address - Phone:319-249-0307
Mailing Address - Fax:319-358-2367
Practice Address - Street 1:1290 JORDAN ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8020
Practice Address - Country:US
Practice Address - Phone:319-249-0307
Practice Address - Fax:319-358-2367
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042628A103TC2200X
IA001297103TC2200X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist