Provider Demographics
NPI:1821410325
Name:MATHEW QUASCHNICK
Entity Type:Organization
Organization Name:MATHEW QUASCHNICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:QUASCHNICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:952-210-3266
Mailing Address - Street 1:13220 UPTON AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2160
Mailing Address - Country:US
Mailing Address - Phone:952-210-3266
Mailing Address - Fax:
Practice Address - Street 1:3754 PLEASANT AVE STE 205
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1279
Practice Address - Country:US
Practice Address - Phone:952-210-3266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN636251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health