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General NPI Number Information
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NPI Number | 1346758877
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Entity Type | Individual
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Provider Name | ABBY ROSE SWANDAL LADC, LAMFT
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Gender | Female
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 901 TWELVE OAKS CENTER DR STE 926D
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City | WAYZATA
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State | MN
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Zip | 55391-4720
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Country | US
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Telephone | 612-491-6158
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Fax |
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Provider Business Mailing Address
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Address Line | 725 LANEWOOD LN N
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City | PLYMOUTH
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State | MN
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Zip | 55447-4345
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Country | US
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Telephone | 763-228-1103
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3617
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License Number State | MN
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