Individual
MACIE ANN VANMATRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8090 W 5TH ST UNIT 1, RATHDRUM, ID 83858-7255
(208) 457-2544
Mailing address
8090 W 5TH ST UNIT 1, RATHDRUM, ID 83858-7255
(208) 457-2544
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/14/2025
Last updated
09/11/2025
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