Individual
TIMOTHY SWANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LCPC, LPC
Contact information
Practice address
1 1/2 W GENEVA ST, ELKHORN, WI 53121-1722
(262) 723-3424
(262) 723-8308
Mailing address
1 1/2 W GENEVA ST, ELKHORN, WI 53121-1722
(262) 723-3424
(262) 723-8308
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180-000950
IL
101YP2500X
Professional Counselor
Primary
5120-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124039367
—
WI
01
—
5615096
BC/BS OF AMERICA
IL
Enumeration date
08/11/2006
Last updated
08/20/2013
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