Provider Demographics
NPI:1629259528
Name:MATESKI, MARIE LOUISE (MALP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:MATESKI
Suffix:
Gender:F
Credentials:MALP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST
Mailing Address - Street 2:ASSESSMENT AND REFERRAL
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-8514
Mailing Address - Fax:612-863-8516
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:STE 450
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:612-863-8511
Practice Address - Fax:612-863-8516
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional