Provider Demographics
NPI:1871036483
Name:SWANCUTT, RENAUX RYLEE (LSW)
Entity Type:Individual
Prefix:
First Name:RENAUX
Middle Name:RYLEE
Last Name:SWANCUTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5039
Mailing Address - Country:US
Mailing Address - Phone:507-990-6804
Mailing Address - Fax:
Practice Address - Street 1:2215 2ND ST SW
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4147
Practice Address - Country:US
Practice Address - Phone:507-218-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker