Individual
MS. KATHLEEN ANN MATHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
4959 OLSON MEMORIAL HWY STE B, GOLDEN VALLEY, MN 55422-5159
(763) 432-4071
(763) 432-4073
Mailing address
4959 OLSON MEMORIAL HWY STE B, GOLDEN VALLEY, MN 55422-5159
(612) 978-3209
(763) 270-5915
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10410
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800002341
MEDICARE PTAN
MN
05
—
917026000
—
MN
Enumeration date
10/02/2006
Last updated
02/09/2019
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