Mattison-Wynn, Mary G

Mattison-Wynn, Mary G is an individual health care provider with primary practice located at 9550 Upland Ln N Ste 120 , Maple Grove MN 55369. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Psychologist is her primary health care specialty. Mattison-Wynn, Mary G can be contacted via phone (763) 537-6000.

Contact Information

Primary practice address
9550 Upland Ln N Ste 120 Maple Grove MN 55369
Phone: (763) 537-6000
Fax: (763) 537-6666
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X 4961 Minnesota
Behavioral Health & Social Service Providers / Psychologist 103T00000X LP4961 Minnesota

Profile Details

NPI number 1649202755
LBN Legal business name Mattison-Wynn, Mary G
Credentials PSY D LP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2006
Last updated Jun 28th, 2019 - about 5 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 1649202755 NPPES
South Dakota MEDICAID P426

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