Provider Demographics
NPI:1982898292
Name:MATTHEW RUSHLAU EDD, LLC
Entity Type:Organization
Organization Name:MATTHEW RUSHLAU EDD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHLAU
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:269-567-5912
Mailing Address - Street 1:4021 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3706
Mailing Address - Country:US
Mailing Address - Phone:269-384-6055
Mailing Address - Fax:269-384-6056
Practice Address - Street 1:4031 W MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-3730
Practice Address - Country:US
Practice Address - Phone:269-567-4202
Practice Address - Fax:269-344-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010494103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C912030OtherBLUE CROSS