Individual
MATTHEW IWATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
1060 GRAND AVE UNIT 211, SAINT PAUL, MN 55105-3820
(612) 208-2865
Mailing address
2136 FORD PKWY # 5481, SAINT PAUL, MN 55116-2850
(612) 208-2865
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24616
MN
Other
Enumeration date
12/26/2022
Last updated
12/26/2022
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