Provider Demographics
NPI:1720413008
Name:SWANSON, MARGIT ALICE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARGIT
Middle Name:ALICE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2617
Mailing Address - Country:US
Mailing Address - Phone:651-261-1208
Mailing Address - Fax:
Practice Address - Street 1:8647 EAGLE POINT BLVD
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8655
Practice Address - Country:US
Practice Address - Phone:651-505-3273
Practice Address - Fax:855-344-4350
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000000OtherPENDING MEDICARE PIN