Individual
ROBERTA LEE MATHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMFT
Contact information
Practice address
610 FLORENCE AVE, OWATONNA, MN 55060-4704
(507) 451-2630
(507) 455-8133
Mailing address
610 FLORENCE AVE, OWATONNA, MN 55060-4704
(507) 451-2630
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1331
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
485048300
—
MN
01
—
57443SK
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/12/2006
Last updated
02/10/2021
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