Provider Demographics
NPI:1912242181
Name:SWANSON, MISTI M (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MISTI
Middle Name:M
Last Name:SWANSON
Suffix:
Gender:F
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 1:1104 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-2903
Mailing Address - Country:US
Mailing Address - Phone:414-737-1590
Mailing Address - Fax:
Practice Address - Street 1:1104 W 10TH ST
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-2903
Practice Address - Country:US
Practice Address - Phone:414-737-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7959-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical