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General NPI Number Information
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NPI Number | 1083700504
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Entity Type | Individual
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Provider Name | VICTORIA LEE SWANSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 4899 MILLER TRUNK HWY STE 208
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City | HERMANTOWN
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State | MN
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Zip | 55811
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Country | US
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Telephone | 218-727-3888
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Fax | 218-260-4772
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Provider Business Mailing Address
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Address Line | 4899 MILLER TRUNK HWY STE 208
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City | HERMANTOWN
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State | MN
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Zip | 55811-1582
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Country | US
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Telephone | 218-727-3888
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Fax | 218-260-4772
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16814
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License Number State | MN
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