Provider Demographics
NPI:1699597351
Name:MATTESON, KAITLYN (MA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:MATTESON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-0974
Mailing Address - Country:US
Mailing Address - Phone:651-755-4276
Mailing Address - Fax:888-972-5307
Practice Address - Street 1:6230 10TH ST N STE 220
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6160
Practice Address - Country:US
Practice Address - Phone:651-755-4276
Practice Address - Fax:888-972-5307
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor