=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740429307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWENSON PSYCHOLOGICAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2009
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2970 JUDICIAL RD STE 100
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-7822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-224-8990
-----------------------------------------------------
Fax | 952-224-8991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2970 JUDICIAL RD STE 100
-----------------------------------------------------
City | BURNSVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55337-7822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-224-8990
-----------------------------------------------------
Fax | 952-224-8991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | KATHRYN CASHMAN
-----------------------------------------------------
Credential | LP
-----------------------------------------------------
Telephone | 612-598-3891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1739
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | 1595
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 4312
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------