Individual provider Active NPI

Matthew L Fetrow

  • Clinical Social Worker
  • Pearland, TX
National Provider Identifier
1689274763
Registry record updated Apr 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.023548 Issued in IL
Practice address
3408 Westminister St
Pearland, TX 77581-4844
Phone
(832) 736-4888
NPI assigned
Oct 28, 2020
Last updated
Apr 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X 12567-123 WI
Clinical Social Worker 1041C0700X 149.023548 IL Primary

Addresses

Primary practice location

3408 Westminister St
Pearland, TX 77581-4844

Mailing address

N1547 Overlook Dr
Genoa City, WI 53128-1592
Phone (346) 812-1372

Other practice location 1

N1547 Overlook Dr
Genoa City, WI 53128-1592
Phone (346) 812-1372

Other practice location 2

3001 Green Bay Rd Bldg 7
North Chicago, IL 60064-3048
Phone (224) 610-4938

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
149.023548ILMDClinical Social Worker
12567-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Captain James a Lovell Federal Health Care Center CurrentSince Nov 1, 2020 Accepting new patients
Sturdy Roots Whole Health LLC CurrentSince Jul 9, 2025 Accepting new patients

Locations

3001 Green Bay Rd
Bldg 7
North Chicago, IL 60064
Phone (224) 610-4938

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775174400000",
    "number": "1689274763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N1547 OVERLOOK DR",
            "city": "GENOA CITY",
            "state": "WI",
            "postal_code": "531281592",
            "telephone_number": "346-812-1372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3408 WESTMINISTER ST",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775814844",
            "telephone_number": "832-736-4888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "N1547 Overlook Dr",
            "address_purpose": "LOCATION",
            "city": "Genoa City",
            "state": "WI",
            "postal_code": "531281592",
            "country_code": "US",
            "telephone_number": "346-812-1372",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3001 Green Bay Rd Bldg 7",
            "address_purpose": "LOCATION",
            "city": "North Chicago",
            "state": "IL",
            "postal_code": "600643048",
            "country_code": "US",
            "telephone_number": "224-610-4938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FETROW",
        "first_name": "MATTHEW",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-28",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "12567-123",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.023548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.