Provider Demographics
NPI:1740328061
Name:SWARTHOUT, DAVID BRIAN (PSY,D)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:SWARTHOUT
Suffix:
Gender:M
Credentials:PSY,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 WILLOW ST STE 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3289
Mailing Address - Country:US
Mailing Address - Phone:612-396-6949
Mailing Address - Fax:888-314-7340
Practice Address - Street 1:1409 WILLOW ST STE 305
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3289
Practice Address - Country:US
Practice Address - Phone:612-396-6949
Practice Address - Fax:888-314-7340
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNON FILEMedicaid