Healthcare Provider Details

I. General information

NPI: 1538325485
Provider Name (Legal Business Name): ERIN K SWANSON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 GRANT ST
HARVARD IL
60033-1821
US

IV. Provider business mailing address

6910 MEADOW DR
CRYSTAL LAKE IL
60012-3240
US

V. Phone/Fax

Practice location:
  • Phone: 815-943-5431
  • Fax: 815-943-0659
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number896876
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164-003690
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: