Basic Information
| Provider Information | |||||||||
| NPI: | 1700972825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTHEW | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | N7193 3RD CRT | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153471311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 209 PRENTICE ST. NORTH | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153444611 | ||||||||
| FaxNumber: | 7153448127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 2434-057 | WI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.