Provider Demographics
NPI:1649339953
Name:SWENSON, KENT NOLAN (MSW)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:NOLAN
Last Name:SWENSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 COMO AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108
Mailing Address - Country:US
Mailing Address - Phone:651-999-4648
Mailing Address - Fax:651-645-7307
Practice Address - Street 1:1821 UNIVERSITY AVENUE WEST
Practice Address - Street 2:N464
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-659-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4S28S8100Medicaid
MN327S7SWOtherBLUE CROSS BLUE SHIELD
MN6247383OtherUBH