Provider Demographics
NPI:1346758877
Name:SWANDAL, ABBY ROSE (LADC, LAMFT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:ROSE
Last Name:SWANDAL
Suffix:
Gender:F
Credentials:LADC, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 LANEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4345
Mailing Address - Country:US
Mailing Address - Phone:763-228-1103
Mailing Address - Fax:
Practice Address - Street 1:901 TWELVE OAKS CENTER DR STE 926D
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4720
Practice Address - Country:US
Practice Address - Phone:612-491-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3617106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist