| Doctor Name: | MR. JEREMEY WAYNE SWANSON |
| NPI Number: | 1174802979 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC |
| License Number: | 302519 |
| Business Practice Address: | 7700 Hudson Rd Suite 600 Woodbury, MN - 551251490 |
| Business Phone Number: | 6517310037 |
| Business Fax Number: | 6517316986 |
| Mailing Address: | 37 Windsor Wood Path, HUDSON |
| State: | WI |
| Postal Code: | 540167772 |
| Phone Number: | 6517558406 |
| Fax Number: | 6517316986 |
| NPI Enumeration Date: | 08/10/2011 |
| NPI Last Update Date: | 08/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 302519 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |