Provider Demographics
NPI:1093330805
Name:SWAIN, SHAVON (LICSW)
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55427-2266
Mailing Address - Country:US
Mailing Address - Phone:763-587-5104
Mailing Address - Fax:
Practice Address - Street 1:6721 VALLEY PL
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55427-2266
Practice Address - Country:US
Practice Address - Phone:763-587-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN247601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical