Provider Demographics
NPI:1053642652
Name:MATSON, KATE ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:ELIZABETH
Last Name:MATSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:KATE
Other - Middle Name:ELIZABETH
Other - Last Name:NOKLEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1731 WEST . SUPERIOR STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806
Mailing Address - Country:US
Mailing Address - Phone:218-733-1331
Mailing Address - Fax:
Practice Address - Street 1:5095 FISH LAKE ROAD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803
Practice Address - Country:US
Practice Address - Phone:218-733-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN154421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical