Provider Demographics
NPI:1093379802
Name:SWANSON, ARIEL E (LCSW)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:E
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:E
Other - Last Name:POZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 PARK AVE E
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-3903
Mailing Address - Country:US
Mailing Address - Phone:815-875-4531
Mailing Address - Fax:815-876-2119
Practice Address - Street 1:535 PARK AVE E
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356
Practice Address - Country:US
Practice Address - Phone:815-875-4531
Practice Address - Fax:815-876-2118
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490204351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149020435Medicaid