Provider Demographics
NPI:1417629114
Name:SWANSON, BROOKE ANN (MS, LPCC)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ANN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-7306
Mailing Address - Country:US
Mailing Address - Phone:218-855-8767
Mailing Address - Fax:
Practice Address - Street 1:11615 STATE AVE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-7306
Practice Address - Country:US
Practice Address - Phone:218-855-8767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health