Provider Demographics
NPI:1063680650
Name:SWENSON, ING ERIK (LCSW, CRADC)
Entity Type:Individual
Prefix:
First Name:ING
Middle Name:ERIK
Last Name:SWENSON
Suffix:
Gender:M
Credentials:LCSW, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3656 N HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5974
Mailing Address - Country:US
Mailing Address - Phone:773-472-6469
Mailing Address - Fax:
Practice Address - Street 1:3656 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5974
Practice Address - Country:US
Practice Address - Phone:773-472-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
WALW00009364101YM0800X
CALCS 285491041C0700X
IL149.017451104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical