Healthcare Provider Details

I. General information

NPI: 1043506116
Provider Name (Legal Business Name): TREVOR SWOVERLAND MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST STE 620
DULUTH MN
55802-1723
US

IV. Provider business mailing address

324 W SUPERIOR ST STE 620
DULUTH MN
55802-1723
US

V. Phone/Fax

Practice location:
  • Phone: 218-606-1797
  • Fax: 651-925-0039
Mailing address:
  • Phone: 218-606-1797
  • Fax: 651-925-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19440
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: