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General NPI Number Information
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NPI Number | 1861472276
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Entity Type | Individual
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Provider Name | MATTHEW RONALD DOWLING MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 5100 EDEN AVE STE. 108
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City | EDINA
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State | MN
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Zip | 55436
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Country | US
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Telephone | 612-360-3843
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Fax | 952-929-4581
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Provider Business Mailing Address
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Address Line | 5100 EDEN AVE STE. 108
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City | EDINA
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State | MN
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Zip | 55436
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Country | US
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Telephone | 612-360-3843
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Fax | 952-929-4581
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14602
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 14602
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License Number State |
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