Provider Demographics
NPI:1740429307
Name:SWENSON PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SWENSON PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:CASHMAN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:612-598-3891
Mailing Address - Street 1:2970 JUDICIAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7822
Mailing Address - Country:US
Mailing Address - Phone:952-224-8990
Mailing Address - Fax:952-224-8991
Practice Address - Street 1:2970 JUDICIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-7822
Practice Address - Country:US
Practice Address - Phone:952-224-8990
Practice Address - Fax:952-224-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4312103T00000X
MN1739106H00000X
MN1595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN389226300Medicaid
MN1326025313OtherNPPES
MN1326025313OtherNPPES