Provider Demographics
NPI:1003302621
Name:KIDDER, MATTHEW SPRAGUE
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SPRAGUE
Last Name:KIDDER
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 1:7330 SE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8404
Mailing Address - Country:US
Mailing Address - Phone:503-358-2891
Mailing Address - Fax:
Practice Address - Street 1:7330 SE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8404
Practice Address - Country:US
Practice Address - Phone:503-358-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor