Provider Demographics
NPI:1851056006
Name:SWOBODA KRUG, CATHERINE (CHW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SWOBODA KRUG
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE S306A
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2874
Mailing Address - Country:US
Mailing Address - Phone:651-315-4905
Mailing Address - Fax:
Practice Address - Street 1:1821 UNIVERSITY AVE W STE S306A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2874
Practice Address - Country:US
Practice Address - Phone:651-315-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker