Provider Demographics
NPI:1588464804
Name:MATTFELD, AUTUMN I
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:I
Last Name:MATTFELD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 26TH AVE SE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2641
Mailing Address - Country:US
Mailing Address - Phone:218-671-5932
Mailing Address - Fax:
Practice Address - Street 1:1015 26TH AVE SE UNIT B
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2641
Practice Address - Country:US
Practice Address - Phone:218-671-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician