Provider Demographics
NPI:1003629478
Name:SWANSON, MALLORY (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 I ST STE 305
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-2215
Mailing Address - Country:US
Mailing Address - Phone:812-902-2545
Mailing Address - Fax:
Practice Address - Street 1:405 I ST STE 305
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-2215
Practice Address - Country:US
Practice Address - Phone:812-902-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011292A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty