MEDICARE: SUZANNIE M JAMES-SVEBACK LAMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2362	MN

General Provider Information

NPI Number	:	1639446875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNIE M JAMES-SVEBACK LAMFT

Provider Business Mailing Address
First Line	:	18986 LAKE DR E
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9348
Country	:	US
Telephone Number	:	952-767-3678
Fax Number	:	612-869-6743

Provider Business Practice Location Address
First Line	:	18986 LAKE DR E
Second Line	:
City	:	CHANHASSEN
State	:	MN
Zip	:	55317-9348
Country	:	US
Telephone Number	:	952-767-3678
Fax Number	:	612-869-6743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	07/06/2021

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