Provider Demographics
NPI:1689378903
Name:SWARDSON, RAQUEL SNOW (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:SNOW
Last Name:SWARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2732
Mailing Address - Country:US
Mailing Address - Phone:260-414-5090
Mailing Address - Fax:
Practice Address - Street 1:1824 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-2732
Practice Address - Country:US
Practice Address - Phone:260-414-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008393A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty