MEDICARE: ING ERIK SWENSON LCSW, CRADC

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	101Y00000X	Counselor		CA
2	101YM0800X	Mental Health Counselor	LW00009364	WA
3	1041C0700X	Clinical Social Worker	LCS 28549	CA
4	104100000X	Social Worker	149.017451	IL

General Provider Information

NPI Number	:	1063680650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ING ERIK SWENSON LCSW, CRADC

Provider Business Mailing Address
First Line	:	3656 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5974
Country	:	US
Telephone Number	:	773-472-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	3656 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5974
Country	:	US
Telephone Number	:	773-472-6469
Fax Number	:

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

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	10/27/2022

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