Provider Demographics
NPI:1366467565
Name:MATTHES, SANDRA (MA PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MATTHES
Suffix:
Gender:F
Credentials:MA PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2346
Mailing Address - Country:US
Mailing Address - Phone:816-753-2396
Mailing Address - Fax:
Practice Address - Street 1:4929 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2346
Practice Address - Country:US
Practice Address - Phone:816-753-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY00762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist