Provider Demographics
NPI:1962818534
Name:MATSKO, KEN JOHN JR (MS BSL)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:JOHN
Last Name:MATSKO
Suffix:JR
Gender:M
Credentials:MS BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:PA
Mailing Address - Zip Code:18517-2106
Mailing Address - Country:US
Mailing Address - Phone:570-589-1292
Mailing Address - Fax:
Practice Address - Street 1:1104 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-2106
Practice Address - Country:US
Practice Address - Phone:570-589-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001844103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst