Provider Demographics
NPI:1548385792
Name:RUSHLAU, MATTHEW G (EDD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:RUSHLAU
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 W MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3730
Mailing Address - Country:US
Mailing Address - Phone:269-373-4566
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010494103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist