Healthcare Provider Details

I. General information

NPI: 1215328190
Provider Name (Legal Business Name): DONNA SWANSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10204 BODE ST STE B
PLAINFIELD IL
60585-9813
US

IV. Provider business mailing address

10204 BODE ST STE B
PLAINFIELD IL
60585-9813
US

V. Phone/Fax

Practice location:
  • Phone: 855-241-7160
  • Fax: 954-324-8354
Mailing address:
  • Phone: 855-241-7160
  • Fax: 954-324-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-009082
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: