Provider Demographics
NPI:1023341450
Name:MATTHEWS HAMBERG, ABIGAIL LAURIE (PHD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LAURIE
Last Name:MATTHEWS HAMBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:LAURIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-3026
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:513-636-3677
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-3026
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:513-636-3677
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7051103TC0700X
MN5340103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical