Healthcare Provider Details

I. General information

NPI: 1346934973
Provider Name (Legal Business Name): FAITH LORRAINE LIEDHOLM MATSCH HICKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 FORD PKWY STE 106
SAINT PAUL MN
55116-3412
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 612-915-0049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10310
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: