Healthcare Provider Details

I. General information

NPI: 1740429307
Provider Name (Legal Business Name): SWENSON PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 JUDICIAL RD STE 100
BURNSVILLE MN
55337-7822
US

IV. Provider business mailing address

2970 JUDICIAL RD STE 100
BURNSVILLE MN
55337-7822
US

V. Phone/Fax

Practice location:
  • Phone: 952-224-8990
  • Fax: 952-224-8991
Mailing address:
  • Phone: 952-224-8990
  • Fax: 952-224-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4312
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1739
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1595
License Number StateMN

VIII. Authorized Official

Name: KATHRYN CASHMAN
Title or Position: CLINICAL DIRECTOR
Credential: LP
Phone: 612-598-3891