Healthcare Provider Details

I. General information

NPI: 1629321609
Provider Name (Legal Business Name): KATALIN RYAN SWANSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATALIN RYAN GARDNER M.S.

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HERITAGE WAY NE SUITE 302
LEESBURG VA
20176-4544
US

IV. Provider business mailing address

102 HERITAGE WAY NE SUITE 302
LEESBURG VA
20176-4544
US

V. Phone/Fax

Practice location:
  • Phone: 703-771-5100
  • Fax: 703-777-0170
Mailing address:
  • Phone: 703-771-5100
  • Fax: 703-777-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: