Healthcare Provider Details

I. General information

NPI: 1437416377
Provider Name (Legal Business Name): LEAH BAHN SWIFT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 N HIGHWAY 101 STE A
DEPOE BAY OR
97341-9572
US

IV. Provider business mailing address

PO BOX 2847
CORVALLIS OR
97339-2847
US

V. Phone/Fax

Practice location:
  • Phone: 541-765-3265
  • Fax: 541-765-3260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2015-01414
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO204314
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: