Provider Demographics
NPI:1356409429
Name:FRISK, MATTHEW T (AU-D)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:FRISK
Suffix:
Gender:M
Credentials:AU-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 12TH AVE S
Mailing Address - Street 2:SUITE D
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8723
Mailing Address - Country:US
Mailing Address - Phone:701-235-1924
Mailing Address - Fax:701-235-6304
Practice Address - Street 1:2700 12TH AVE S
Practice Address - Street 2:SUITE D
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8723
Practice Address - Country:US
Practice Address - Phone:701-235-1924
Practice Address - Fax:701-235-6304
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND713231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND52670Medicaid
ND52670Medicaid