Basic Information
| Provider Information | |||||||||
| NPI: | 1922381516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUMMINS | ||||||||
| FirstName: | MIRA | ||||||||
| MiddleName: | ELTON ROSE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SWANSON | ||||||||
| OtherFirstName: | MIRA | ||||||||
| OtherMiddleName: | ELTON ROSE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 345 N. SMITH AVE, MAIL STOP 70-503 | ||||||||
| Address2: | CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512206479 | ||||||||
| FaxNumber: | 6512206393 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 N. SMITH AVE, MAIL STOP 70-503 | ||||||||
| Address2: | CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512206479 | ||||||||
| FaxNumber: | 6512206393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2011 | ||||||||
| LastUpdateDate: | 12/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 19684 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.