Provider Demographics
NPI:1982638532
Name:SWENSON, MARK A (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:SWENSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ELM ST.
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-239-3756
Mailing Address - Fax:701-239-2462
Practice Address - Street 1:2101 ELM ST.
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102
Practice Address - Country:US
Practice Address - Phone:701-239-3756
Practice Address - Fax:701-239-2462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0023061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical