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235 W Main St Ste F Perham MN 56573-1448 | |
| (218) 325-2806 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 235 W Main St Ste F, Perham, Minnesota |
| Authorized Official Name and Position | Katelyn Swanson (MENTAL HEALTH PROFESSIONAL) |
| Authorized Official Contact | 2183251084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1205 N Tower Rd Fergus Falls MN 56537-1077 Ph: () - | 235 W Main St Ste F Perham MN 56573-1448 Ph: (218) 325-2806 |
| NPI Number | 1891546032 |
|---|---|
| Provider Enumeration Date | 03/27/2024 |
| Last Update Date | 11/04/2024 |
| Certification Date | 11/04/2024 |
| Medicare PECOS PAC ID | 7113462458 |
|---|---|
| Medicare Enrollment ID | O20240711001335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891546032 | NPI | - | NPPES |
| Provider Name | Katelyn De Swanson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962917419 PECOS PAC ID: 9537521240 Enrollment ID: I20230811002979 |
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