Kathleen Ann Mathews, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10410 Issued in MN

Practice address

4959 Olson Memorial Hwy Ste B
Golden Valley, MN 55422-5159

Phone

(763) 432-4071

Fax

(763) 432-4073

NPI assigned

Oct 2, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549670400000",
    "number": "1104919356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4959 OLSON MEMORIAL HWY STE B",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554225159",
            "telephone_number": "612-978-3209",
            "fax_number": "763-270-5915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4959 OLSON MEMORIAL HWY STE B",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554225159",
            "telephone_number": "763-432-4071",
            "fax_number": "763-432-4073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEWS",
        "first_name": "KATHLEEN",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2019-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "10410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "800002341",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "917026000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Marsh, LPCC
• Katie Marie Marsh, M.A., LPCC
• Steve Marti
• Carrie Lynn Sommars Maruska, D.P.T.
• Lee Ann Mae Mateffy, OTR L
• Anika Mathur
• Maxim Healthcare Services Inc
• Mayfair Home Medical
• Burke Rafer Mays, D.C.
• Erica D Mbangamoh, SLP

• Clinical Social Worker in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.