Healthcare Provider Details

I. General information

NPI: 1023795523
Provider Name (Legal Business Name): EMMA MATHESON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 MANSFIELD DR
GREENDALE WI
53129-1229
US

IV. Provider business mailing address

6420 MANSFIELD DR
GREENDALE WI
53129-1229
US

V. Phone/Fax

Practice location:
  • Phone: 440-222-5805
  • Fax:
Mailing address:
  • Phone: 440-222-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2309276
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2309276
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: