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NPI Code Detail

MEDICARE: MR. BRUCE SWANSON QMHP

MEDICARE: MR. BRUCE SWANSON QMHP
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
11041C0700XClinical Social Worker3580OR
21041C0700XClinical Social WorkerLCS 10264CA

General Provider Information

NPI Number : 1689884892
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE SWANSON QMHP
Provider Business Mailing Address
First Line : 1975 MCPHERSON ST
Second Line : SUITE 2
City : NORTH BEND
State : OR
Zip : 97459-3482
Country : US
Telephone Number : 541-751-7265
Fax Number : 541-756-8982
Provider Business Practice Location Address
First Line : 1975 MCPHERSON ST
Second Line : SUITE 2
City : NORTH BEND
State : OR
Zip : 97459-3482
Country : US
Telephone Number : 541-751-7265
Fax Number : 541-756-8982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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Directions to “ MR. BRUCE SWANSON QMHP” Practice Location

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