Provider Demographics
NPI:1710747662
Name:MATTKE, ALLISON PAIGE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PAIGE
Last Name:MATTKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:PAIGE
Other - Last Name:MATTKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1015 RATONE ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5137
Mailing Address - Country:US
Mailing Address - Phone:785-743-8567
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE STE E230
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2818
Practice Address - Country:US
Practice Address - Phone:785-587-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSBACB1072107103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst