Provider Demographics
NPI:1477540243
Name:MATTEK, PATRIC WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRIC
Middle Name:WILLIAM
Last Name:MATTEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W206S7867 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-9532
Mailing Address - Country:US
Mailing Address - Phone:262-971-5015
Mailing Address - Fax:
Practice Address - Street 1:970 S SILVER LAKE ST STE 102
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3802
Practice Address - Country:US
Practice Address - Phone:262-569-7100
Practice Address - Fax:262-567-6295
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2508-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40938300Medicaid