Provider Demographics
NPI:1538274600
Name:SWAN, REBECCA R (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:R
Last Name:SWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:900 AMERICAN BLVD E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1392
Mailing Address - Country:US
Mailing Address - Phone:952-854-2622
Mailing Address - Fax:952-854-3293
Practice Address - Street 1:900 AMERICAN BLVD E
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1392
Practice Address - Country:US
Practice Address - Phone:952-854-2622
Practice Address - Fax:952-854-3293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical