Clark, Matthew M.

Clark, Matthew M. is an individual health care provider with primary practice located at 200 1St St Sw , Rochester MN 55905-0001. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Clark, Matthew M. can be contacted via phone (507) 284-2511.

Contact Information

Primary practice address
200 1St St Sw Rochester MN 55905-0001
Phone: (507) 284-2511
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP4101 Minnesota

Profile Details

NPI number 1366420895
LBN Legal business name Clark, Matthew M.
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 5th, 2006
Last updated Aug 24th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366420895 NPPES
Minnesota MEDICAID 166326700

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