Individual
DR. MARY THERESA SWENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDD
Contact information
Practice address
13750 CROSSTOWN DR PHASE II, SUITE 207, HAM LAKE, MN 55304-2664
(763) 413-6971
Mailing address
13750 CROSSTOWN DR NW, MOLLY PROFESSIONAL CENTER PHASE II SUITE 207, ANDOVER, MN 55304
(763) 755-6290
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
00808
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01405
STATE LICENSE
MN
Enumeration date
06/05/2014
Last updated
12/01/2014
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