MEDICARE: LINDSAY MARIE MATTI MSW. LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	25692	MN

General Provider Information

NPI Number	:	1962938704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY MARIE MATTI MSW. LICSW

Provider Business Mailing Address
First Line	:	2303 14TH ST
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-2959
Country	:	US
Telephone Number	:	218-349-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 MILLER TRUNK HWY STE 214
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4448
Country	:	US
Telephone Number	:	218-727-3888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	09/20/2022

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