Provider Demographics
NPI:1063077220
Name:SWANSON, KIMBERLY (LPCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14325 CORMORANT WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-7113
Mailing Address - Country:US
Mailing Address - Phone:612-532-8455
Mailing Address - Fax:
Practice Address - Street 1:14325 CORMORANT WAY
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-7113
Practice Address - Country:US
Practice Address - Phone:612-532-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health