Provider Demographics
NPI:1982026258
Name:QUASCHNICK, MATHEW DWIGHT (LPCC)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:DWIGHT
Last Name:QUASCHNICK
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 W LAKE ST
Mailing Address - Street 2:204
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2653
Mailing Address - Country:US
Mailing Address - Phone:952-210-3266
Mailing Address - Fax:
Practice Address - Street 1:1406 W LAKE ST
Practice Address - Street 2:204
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2653
Practice Address - Country:US
Practice Address - Phone:952-210-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN423652100Medicaid