Provider Demographics
NPI:1992201511
Name:SWENSON, KATIE JENE GARREY (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JENE GARREY
Last Name:SWENSON
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15221 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5364
Mailing Address - Country:US
Mailing Address - Phone:605-929-2477
Mailing Address - Fax:
Practice Address - Street 1:823 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-454-3826
Practice Address - Fax:218-454-1024
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional