Provider Demographics
NPI:1073908265
Name:SWINGHOLM MIRELES, ERICA
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:SWINGHOLM MIRELES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2837
Mailing Address - Country:US
Mailing Address - Phone:509-301-2720
Mailing Address - Fax:
Practice Address - Street 1:401 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2837
Practice Address - Country:US
Practice Address - Phone:509-301-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC605512751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical