Provider Demographics
NPI:1366994527
Name:SVENDDAL, TANYA MARIE (MA LADC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:SVENDDAL
Suffix:
Gender:F
Credentials:MA LADC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:FINNEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3833 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 120
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2643
Practice Address - Country:US
Practice Address - Phone:763-767-3350
Practice Address - Fax:763-767-0912
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health