Provider Demographics
NPI:1740611508
Name:SWANSON, KATHRYN TASSE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:TASSE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TASSSE
Other - Middle Name:
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:3070 W OWASSO BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2161
Mailing Address - Country:US
Mailing Address - Phone:612-873-2662
Mailing Address - Fax:612-873-1987
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:PPB #404
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-2662
Practice Address - Fax:612-873-1987
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist