Healthcare Provider Details

I. General information

NPI: 1649678848
Provider Name (Legal Business Name): AMY LOUISE-VANNURDEN SWINGLE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2014
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HUNDERTMARK RD STE 205N
CHASKA MN
55318-1586
US

IV. Provider business mailing address

9400 ZANE AVE N
BROOKLYN PARK MN
55443-1814
US

V. Phone/Fax

Practice location:
  • Phone: 952-903-1350
  • Fax: 952-426-3856
Mailing address:
  • Phone: 763-762-8800
  • Fax: 763-315-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5862
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: