Provider Demographics
NPI:1811569544
Name:MATTSON, RHONDA RENEE (CSAC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:RENEE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3224
Mailing Address - Country:US
Mailing Address - Phone:414-885-3521
Mailing Address - Fax:262-643-4617
Practice Address - Street 1:1415 DUKE ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1317
Practice Address - Country:US
Practice Address - Phone:715-418-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16459-131101YA0400X
WI17023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)