Provider Demographics
NPI:1124254503
Name:SWEENEY, WENDY ANNE-MASSMANN (LP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE-MASSMANN
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1955
Mailing Address - Country:US
Mailing Address - Phone:952-920-3708
Mailing Address - Fax:
Practice Address - Street 1:2820 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1955
Practice Address - Country:US
Practice Address - Phone:952-920-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5035103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist