Healthcare Provider Details

I. General information

NPI: 1306769773
Provider Name (Legal Business Name): REBEKAH SWANGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 30TH ST NW
CANTON OH
44709-3112
US

IV. Provider business mailing address

626 30TH ST NW
CANTON OH
44709-3112
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-5015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2608192
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: