Provider Demographics
NPI:1912142712
Name:SCHWENKE, NAOMI JOY (MA, PHD)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:JOY
Last Name:SCHWENKE
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 WASHINGTON AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2469
Mailing Address - Country:US
Mailing Address - Phone:612-464-1400
Mailing Address - Fax:612-315-6001
Practice Address - Street 1:7777 WASHINGTON AVE S STE 101
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2469
Practice Address - Country:US
Practice Address - Phone:612-464-1400
Practice Address - Fax:612-315-6001
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMFT10000007106H00000X
RIMFT00221106H00000X
NY002263106H00000X
MN2773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist