Healthcare Provider Details

I. General information

NPI: 1982638532
Provider Name (Legal Business Name): MARK A SWENSON LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST. VA MEDICAL CENTER
FARGO ND
58102
US

IV. Provider business mailing address

2101 ELM ST. VA MEDICAL CENTER
FARGO ND
58102
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3756
  • Fax: 701-239-2462
Mailing address:
  • Phone: 701-239-3756
  • Fax: 701-239-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002306
License Number StateND

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: