Provider Demographics
NPI:1700972825
Name:MATTHEW, RONALD LEWIS (PHD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEWIS
Last Name:MATTHEW
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:N7193 3RD CRT
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53964
Mailing Address - Country:US
Mailing Address - Phone:715-347-1311
Mailing Address - Fax:
Practice Address - Street 1:209 PRENTICE ST. NORTH
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-344-4611
Practice Address - Fax:715-344-8127
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2434-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist