Provider Demographics
NPI:1376612606
Name:SWAJA, JODI JEAN (LICSW)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:JEAN
Last Name:SWAJA
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 1:103 5TH AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379
Mailing Address - Country:US
Mailing Address - Phone:952-403-9563
Mailing Address - Fax:
Practice Address - Street 1:7675 HIGHWAY 13 W
Practice Address - Street 2:SUITE 102
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1181
Practice Address - Country:US
Practice Address - Phone:952-808-7700
Practice Address - Fax:952-808-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN132921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
6293412OtherUBH
141873OtherUCARE
1023426OtherPREFERREDONE
98D69C0OtherBC BS
HP34907OtherHPARTNERS