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General NPI Number Information
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NPI Number | 1760544290
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Entity Type | Organization
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Legal Business Name | SUZANNE SWANSON INC.
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1108 GRAND AVE #2
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City | SAINT PAUL
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State | MN
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Zip | 55105-2618
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Country | US
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Telephone | 651-221-9709
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Fax |
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Provider Business Mailing Address
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Address Line | 1108 GRAND AVE #2
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City | SAINT PAUL
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State | MN
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Zip | 55105-2618
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Country | US
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Telephone | 651-221-9709
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. SUZANNE M SWANSON
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Credential | PH.D.
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Telephone | 651-221-9709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP2039
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License Number State | MN
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