Provider Demographics
NPI:1073790416
Name:MATZKE, MICHELLE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:R
Last Name:MATZKE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 2ND ST W STE 300
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-3067
Mailing Address - Country:US
Mailing Address - Phone:330-760-6452
Mailing Address - Fax:
Practice Address - Street 1:50 2ND ST W STE 300
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3067
Practice Address - Country:US
Practice Address - Phone:330-760-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6919103TC2200X
MT1953103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent