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NPI Code Detail

MEDICARE: AMY LOUISE-VANNURDEN SWINGLE PSYD

MEDICARE: AMY LOUISE-VANNURDEN SWINGLE PSYD
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
1103TC0700XClinical Psychologist5862MN

General Provider Information

NPI Number : 1649678848
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LOUISE-VANNURDEN SWINGLE PSYD
Provider Business Mailing Address
First Line : 9400 ZANE AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1814
Country : US
Telephone Number : 763-762-8800
Fax Number : 763-315-4669
Provider Business Practice Location Address
First Line : 111 HUNDERTMARK RD STE 205N
Second Line :
City : CHASKA
State : MN
Zip : 55318-1586
Country : US
Telephone Number : 952-903-1350
Fax Number : 952-426-3856
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2014
Last Update Date : 10/29/2020

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