Provider Demographics
NPI:1669873824
Name:INTERPRETIVE LEADERSHIP INC
Entity type:Organization
Organization Name:INTERPRETIVE LEADERSHIP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:858-531-0710
Mailing Address - Street 1:13750 CROSSTOWN DR NW
Mailing Address - Street 2:#207
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-5853
Mailing Address - Country:US
Mailing Address - Phone:858-531-0710
Mailing Address - Fax:
Practice Address - Street 1:2847 180TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-2664
Practice Address - Country:US
Practice Address - Phone:763-413-6971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty