Provider Demographics
NPI:1548537566
Name:MATLOSZ, ERIN TAYLOR (PSYD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:TAYLOR
Last Name:MATLOSZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9580
Mailing Address - Country:US
Mailing Address - Phone:616-365-8920
Mailing Address - Fax:
Practice Address - Street 1:4370 CHICAGO DR SW STE 304
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1694
Practice Address - Country:US
Practice Address - Phone:616-260-7915
Practice Address - Fax:616-333-5394
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-14-15547103K00000X
MI6301015312103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst