MEDICARE: DR. JOSEPH ELLSWORTH SWITRAS PH. D. LICENSED PSYC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	LP2765	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033117650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH ELLSWORTH SWITRAS PH. D. LICENSED PSYC

Provider Business Mailing Address
First Line	:	208 W 2ND ST
Second Line	:	SUITE 116
City	:	FAIRMONT
State	:	MN
Zip	:	56031-1843
Country	:	US
Telephone Number	:	507-235-5651
Fax Number	:	507-235-5651

Provider Business Practice Location Address
First Line	:	208 W 2ND ST
Second Line	:	SUITE 116
City	:	FAIRMONT
State	:	MN
Zip	:	56031-1843
Country	:	US
Telephone Number	:	507-235-5651
Fax Number	:	507-235-5651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/15/2012

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