Provider Demographics
NPI:1083700504
Name:SWANSON, VICTORIA LEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LEE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LEE
Other - Last Name:SUNDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4899 MILLER TRUNK HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1582
Mailing Address - Country:US
Mailing Address - Phone:218-727-3888
Mailing Address - Fax:218-260-4772
Practice Address - Street 1:4899 MILLER TRUNK HWY STE 208
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-727-3888
Practice Address - Fax:218-260-4772
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN168141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical