MEDICARE: DR. SUSAN ANN SWANK PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3580	CO

General Provider Information

NPI Number	:	1275838203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ANN SWANK PSY.D.

Provider Business Mailing Address
First Line	:	822 N SHERIDAN AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4524
Country	:	US
Telephone Number	:	719-439-5683
Fax Number	:	719-255-3302

Provider Business Practice Location Address
First Line	:	3225 TEMPLETON GAP RD
Second Line	:	SUITE 101
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8728
Country	:	US
Telephone Number	:	719-439-5683
Fax Number	:	719-352-3827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2011
Last Update Date	:	06/18/2014

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