Healthcare Provider Details

I. General information

NPI: 1932020344
Provider Name (Legal Business Name): JENICA SWENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 9661
DYESS AFB TX
79607-0661
US

IV. Provider business mailing address

PO BOX 9661
DYESS AFB TX
79607-0661
US

V. Phone/Fax

Practice location:
  • Phone: 850-797-3463
  • Fax:
Mailing address:
  • Phone: 850-797-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number103023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: