Provider Demographics
NPI:1841413507
Name:SWENSON, RODNEY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:A
Last Name:SWENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8201
Mailing Address - Country:US
Mailing Address - Phone:701-297-7588
Mailing Address - Fax:701-364-2256
Practice Address - Street 1:1220 MAIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8201
Practice Address - Country:US
Practice Address - Phone:701-297-7588
Practice Address - Fax:701-364-2256
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17019Medicaid
ND17019Medicaid
NDR02273Medicare UPIN