Healthcare Provider Details

I. General information

NPI: 1902608482
Provider Name (Legal Business Name): TRISHA DENAY SWAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 19 MILE RD
CLINTON TWP MI
48038-3502
US

IV. Provider business mailing address

50571 JEFFERSON AVE APT 4
NEW BALTIMORE MI
48047-2307
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-8700
  • Fax:
Mailing address:
  • Phone: 248-894-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: