Healthcare Provider Details

I. General information

NPI: 1366329252
Provider Name (Legal Business Name): RANDALL SWANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1778 MCGOWAN PKWY
OLIVEHURST CA
95961-4745
US

IV. Provider business mailing address

1778 MCGOWAN PKWY
OLIVEHURST CA
95961-4745
US

V. Phone/Fax

Practice location:
  • Phone: 530-277-7231
  • Fax:
Mailing address:
  • Phone: 530-741-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: