Provider Demographics
NPI:1043954258
Name:MATVIYCHUK, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:MATVIYCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 BELLVIEW ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1013
Mailing Address - Country:US
Mailing Address - Phone:253-222-0769
Mailing Address - Fax:
Practice Address - Street 1:4629 BELLVIEW ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-1013
Practice Address - Country:US
Practice Address - Phone:253-222-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602717472171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0238448OtherINTERPRETER PROVIDER NUMBER