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Organization

SHELLEY BOEHM MATTIA MD,ADULT PSYCHIATRY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SHELLEY KATHRYN BOEHM MATTIA M.D. (LICENSED PHYSICIAN)
(920) 246-4925
Entity
Organization

Contact information

Practice address
428 DOTY ST, GREEN BAY, WI 54301-4509
(920) 965-6768
(920) 965-6769
Mailing address
428 DOTY ST, GREEN BAY, WI 54301-4509
(920) 965-6768
(920) 965-6769

Taxonomy

Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
39641
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32453500
WI
Enumeration date
03/24/2016
Last updated
10/04/2016
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