Provider Demographics
NPI:1073822276
Name:SWAN, LAURA LEE (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:SWAN
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ST.PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-227-4184
Mailing Address - Fax:651-224-5136
Practice Address - Street 1:1089 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-7011
Practice Address - Country:US
Practice Address - Phone:651-227-4184
Practice Address - Fax:651-224-5136
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20374104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker