Provider Demographics
NPI:1275819666
Name:SPITZMUELLER, MATTHEW CHRISTIAN (PHD, LICSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHRISTIAN
Last Name:SPITZMUELLER
Suffix:
Gender:M
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL STE 1005
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2614
Mailing Address - Country:US
Mailing Address - Phone:773-484-3733
Mailing Address - Fax:
Practice Address - Street 1:825 NICOLLET MALL STE 1005
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2614
Practice Address - Country:US
Practice Address - Phone:773-484-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0149641041C0700X
MN323791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical