Provider Demographics
NPI:1417402041
Name:SYVERTSON, VIOLETTA MARIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:VIOLETTA
Middle Name:MARIE
Last Name:SYVERTSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1415
Mailing Address - Country:US
Mailing Address - Phone:218-651-0212
Mailing Address - Fax:218-651-0220
Practice Address - Street 1:421 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1415
Practice Address - Country:US
Practice Address - Phone:218-651-0212
Practice Address - Fax:218-651-0220
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01853101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor