Healthcare Provider Details

I. General information

NPI: 1215596366
Provider Name (Legal Business Name): MICHELL SWENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11343 50TH ST NE
ALBERTVILLE MN
55301-9811
US

IV. Provider business mailing address

11343 50TH ST NE
ALBERTVILLE MN
55301-9811
US

V. Phone/Fax

Practice location:
  • Phone: 763-497-0102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3385
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: