Healthcare Provider Details

I. General information

NPI: 1114369360
Provider Name (Legal Business Name): ETHAN SCHWEHR PHD LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 HIGHWAY 100 S
ST LOUIS PARK MN
55416-2175
US

IV. Provider business mailing address

3200 HIGHWAY 100 S
ST LOUIS PARK MN
55416-2175
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-6377
  • Fax:
Mailing address:
  • Phone: 952-920-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number437594
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: