Provider Demographics
NPI:1376213512
Name:RECKINGER-ROWE, MATTHEW (PHD,CPC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:RECKINGER-ROWE
Suffix:
Gender:M
Credentials:PHD,CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E MULLAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4054
Mailing Address - Country:US
Mailing Address - Phone:208-329-7676
Mailing Address - Fax:208-329-7677
Practice Address - Street 1:1121 E MULLAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4054
Practice Address - Country:US
Practice Address - Phone:208-329-7676
Practice Address - Fax:208-329-7677
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral