Provider Demographics
NPI:1104071331
Name:MATTSON, KATHERINE ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:MATTSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:BAUMGARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5910 SHINGLE CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2322
Mailing Address - Country:US
Mailing Address - Phone:763-569-5200
Mailing Address - Fax:763-569-5201
Practice Address - Street 1:5910 SHINGLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2322
Practice Address - Country:US
Practice Address - Phone:763-569-5200
Practice Address - Fax:763-569-5201
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health