Active NPI
Susan Louise Matejczyk
- Developmental Therapist
- Chesterton, IN
National Provider Identifier
1487218111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 1120 S Calumet Rd Ste 3
Chesterton, IN 46304-3286 - Phone
- (219) 983-9675
- Fax
- (219) 983-9681
- NPI assigned
- Apr 29, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
1120 S Calumet Rd Ste 3
Chesterton, IN 46304-3286
Mailing address
4265 Deer Run CT
Lake Station, IN 46405-2466
Phone (219) 916-8385
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556496000000",
"number": "1487218111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4265 DEER RUN CT",
"city": "LAKE STATION",
"state": "IN",
"postal_code": "464052466",
"telephone_number": "219-916-8385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 S CALUMET RD STE 3",
"city": "CHESTERTON",
"state": "IN",
"postal_code": "463043286",
"telephone_number": "219-983-9675",
"fax_number": "219-983-9681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATEJCZYK",
"first_name": "SUSAN",
"middle_name": "LOUISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-29",
"last_updated": "2019-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesterton, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.