Provider Demographics
NPI:1649381674
Name:MATTHEWS, PATRICIA IRENE ZIBUNG (DR)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:IRENE ZIBUNG
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1461
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98237-1461
Mailing Address - Country:US
Mailing Address - Phone:360-221-4199
Mailing Address - Fax:
Practice Address - Street 1:919 3RD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260
Practice Address - Country:US
Practice Address - Phone:360-221-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA703103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
217000624Medicare ID - Type Unspecified