MEDICARE: YONNA F SWINGHOLM LICSW

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	1041C0700X	Clinical Social Worker	LW00008005	WA
2	1041C0700X	Clinical Social Worker	LCSW68367	CA
3	1041C0700X	Clinical Social Worker	C-11422	NM
4	1041C0700X	Clinical Social Worker	C011972	NC

General Provider Information

NPI Number	:	1124123229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONNA F SWINGHOLM LICSW

Provider Business Mailing Address
First Line	:	1000 CORDOVA PL # 315
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-1725
Country	:	US
Telephone Number	:	206-457-7223
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 FORT BRAGG RD STE 104B
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-7037
Country	:	US
Telephone Number	:	206-457-7223
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	06/07/2023

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