MEDICARE: MR. DAVID SWAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1979	MN

General Provider Information

NPI Number	:	1710267141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID SWAN

Provider Business Mailing Address
First Line	:	7808 SCOTT AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3019
Country	:	US
Telephone Number	:	763-561-3982
Fax Number	:

Provider Business Practice Location Address
First Line	:	7808 SCOTT AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3019
Country	:	US
Telephone Number	:	612-799-2163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	08/17/2011

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Directions to “ MR. DAVID SWAN ” Practice Location

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