MEDICARE: VICTORIA JEAN SWANSON

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	6451024702	MI

General Provider Information

NPI Number	:	1306705959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA JEAN SWANSON

Provider Business Mailing Address
First Line	:	2215 29TH ST SE STE A&B
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-1565
Country	:	US
Telephone Number	:	616-404-7004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 29TH ST SE STE A&B
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-1565
Country	:	US
Telephone Number	:	616-404-7004
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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