Provider Demographics
NPI:1063199537
Name:MATTSON, LIBBY R (MSW)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:R
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:L
Other - Middle Name:
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1700 SE KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-4214
Mailing Address - Country:US
Mailing Address - Phone:816-977-9037
Mailing Address - Fax:
Practice Address - Street 1:5200 MEADOWS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-0086
Practice Address - Country:US
Practice Address - Phone:503-345-3260
Practice Address - Fax:503-345-3052
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker