Healthcare Provider Details

I. General information

NPI: 1164353926
Provider Name (Legal Business Name): MATTHEW MCGRAW SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10635 36TH AVE N
PLYMOUTH MN
55441-2410
US

IV. Provider business mailing address

10635 36TH AVE N
PLYMOUTH MN
55441-2410
US

V. Phone/Fax

Practice location:
  • Phone: 763-504-8800
  • Fax:
Mailing address:
  • Phone: 763-504-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1019844
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: