Provider Demographics
NPI:1710481262
Name:SWANSON, AMBER KAY (LADC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:KAY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2048
Mailing Address - Country:US
Mailing Address - Phone:320-229-3760
Mailing Address - Fax:320-229-3763
Practice Address - Street 1:713 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2048
Practice Address - Country:US
Practice Address - Phone:320-229-3760
Practice Address - Fax:320-229-3763
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302262101YA0400X
MN402262101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)