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General NPI Number Information
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NPI Number | 1033117650
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Entity Type | Individual
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Provider Name | JOSEPH ELLSWORTH SWITRAS PH. D. LICENSED PSYC
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 208 W 2ND ST SUITE 116
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City | FAIRMONT
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State | MN
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Zip | 56031-1843
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Country | US
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Telephone | 507-235-5651
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Fax | 507-235-5651
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Provider Business Mailing Address
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Address Line | 208 W 2ND ST SUITE 116
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City | FAIRMONT
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State | MN
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Zip | 56031-1843
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Country | US
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Telephone | 507-235-5651
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Fax | 507-235-5651
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP2765
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License Number State | MN
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