Healthcare Provider Details

I. General information

NPI: 1811837610
Provider Name (Legal Business Name): JAQUI SWANSON CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DIXON DR
BENTON ME
04901-3829
US

IV. Provider business mailing address

15 DIXON DR
BENTON ME
04901-3829
US

V. Phone/Fax

Practice location:
  • Phone: 207-712-2046
  • Fax:
Mailing address:
  • Phone: 207-712-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: