Provider Demographics
NPI:1144975319
Name:SWANSON, DAVID JOSEPH (LSW,CADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:SWANSON
Suffix:
Gender:M
Credentials:LSW,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9944 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1690
Mailing Address - Country:US
Mailing Address - Phone:708-586-9095
Mailing Address - Fax:
Practice Address - Street 1:9944 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1690
Practice Address - Country:US
Practice Address - Phone:708-586-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106717104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker