Provider Demographics
NPI:1104684190
Name:SWANSON, LAURA PATRICIA (MSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PATRICIA
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:PATRICIA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4102 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1851
Mailing Address - Country:US
Mailing Address - Phone:402-444-7000
Mailing Address - Fax:
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1851
Practice Address - Country:US
Practice Address - Phone:402-444-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7991104100000X
NE13807101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker