Provider Demographics
NPI:1043700545
Name:MATTSON, CHERIE (PLMPH)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:MATTSON
Suffix:
Gender:F
Credentials:PLMPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S E ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-2430
Mailing Address - Country:US
Mailing Address - Phone:308-872-2123
Mailing Address - Fax:
Practice Address - Street 1:1032 S E ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2430
Practice Address - Country:US
Practice Address - Phone:308-872-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health