Provider Demographics
NPI:1699795542
Name:MATHEWS, DONA LYN (PSYD, LP)
Entity type:Individual
Prefix:
First Name:DONA
Middle Name:LYN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE. W
Mailing Address - Street 2:SUITE 163 SOUTH
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1904
Mailing Address - Country:US
Mailing Address - Phone:651-895-4468
Mailing Address - Fax:651-645-7972
Practice Address - Street 1:2550 UNIVERSITY AVE. W
Practice Address - Street 2:SUITE 163 SOUTH
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1904
Practice Address - Country:US
Practice Address - Phone:651-895-4468
Practice Address - Fax:651-645-7972
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4576103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist