Provider Demographics
NPI:1821187600
Name:ZMUDA-SWANSON, ELIZABETH JEAN (MSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:ZMUDA-SWANSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:BETSY
Other - Middle Name:JEAN
Other - Last Name:ZMUDA-SWANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1800 3RD AVE
Mailing Address - Street 2:STE 412
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8026
Mailing Address - Country:US
Mailing Address - Phone:309-786-3006
Mailing Address - Fax:309-786-0205
Practice Address - Street 1:1800 3RD AVE
Practice Address - Street 2:STE 412
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8026
Practice Address - Country:US
Practice Address - Phone:309-786-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0038511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL244638OtherMIDLAND'S CHOICE
IL8106715OtherBLUE CROSS BLUE SHIELD
IL244638OtherMIDLAND'S CHOICE