Active NPI
Randy Judd Swanson, LICSW
- Clinical Social Worker
- Brooklyn Center, MN
National Provider Identifier
1528155140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2758
- Practice address
- 6040 Earle Brown Dr
Brooklyn Center, MN 55430-2514 - Phone
- (952) 666-5896
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2758 | MN | Primary |
Addresses
Primary practice location
6040 Earle Brown Dr
Brooklyn Center, MN 55430-2514
Mailing address
6040 Earle Brown Dr
Brooklyn Center, MN 55430-2514
Phone (763) 213-7405
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 950557100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2758 | MN | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510790400000",
"number": "1528155140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6040 EARLE BROWN DR",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302514",
"telephone_number": "763-213-7405",
"fax_number": "612-879-5272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6040 EARLE BROWN DR",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302514",
"telephone_number": "952-666-5896"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWANSON",
"first_name": "RANDY",
"middle_name": "JUDD",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2017-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "2758",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "950557100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.