Individual
TAMMY MATVICHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
3230 BROADMOOR AVE SE STE D, KENTWOOD, MI 49512-8180
(616) 821-4211
Mailing address
3230 BROADMOOR AVE SE STE D, KENTWOOD, MI 49512-8180
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6362010012
MI
Other
Enumeration date
05/14/2025
Last updated
05/27/2025
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