Justin W Swanson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22271 Issued in MN

Practice address

750 S Plaza Dr Ste 100
Mendota Heights, MN 55120-1505

Phone

(612) 227-9014

Fax

(651) 455-1385

NPI assigned

Apr 17, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Group practices

Residential Transitions IncorporatedGroup PAC ID 1951830801, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Residential Transitions Incorporated

  • Community/Behavioral Health Agency
  • Mendota Heights, MN
  • NPI 1144725623
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1053974865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 GRAND AVE S UNIT 2",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554195430",
            "telephone_number": "612-227-9014",
            "fax_number": "651-455-1385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 S PLAZA DR STE 100",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551201505",
            "telephone_number": "612-227-9014",
            "fax_number": "651-455-1385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWANSON",
        "first_name": "JUSTIN",
        "middle_name": "W",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abdirahman Sugulle
• Vitaly Ana Sukochev, M.A.
• Ingrid Sulistyo
• Camilla Zulieka Sumrall
• Dorothy Swanson
• Thaine Swirtz
• Ken Julian Takekoshi, M.D.
• Natalie Angela Tangness
• Tcoh PC
• Selena Kae Terrazas

• Clinical Social Worker in Mendota Heights, MN
• Providers in Mendota Heights, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.