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NPI Code Detail

MEDICARE: MRS. SHANNON EILEEN SWANSON M.S.W.

MEDICARE: MRS. SHANNON EILEEN SWANSON M.S.W.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1760554380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON EILEEN SWANSON M.S.W.
Provider Business Mailing Address
First Line : 3995 MARCOLA RD
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97477-7948
Country : US
Telephone Number : 541-726-1465
Fax Number :
Provider Business Practice Location Address
First Line : 3995 MARCOLA RD
Second Line :
City : SPRINGFIELD
State : OR
Zip : 97477-7948
Country : US
Telephone Number : 541-726-1465
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 04/29/2024

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