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General NPI Number Information
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NPI Number | 1033741723
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Entity Type | Individual
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Provider Name | CANDACE SWANSON
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Gender | Female
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 3716 DAVIS ST
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City | SKOKIE
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State | IL
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Zip | 60076-1745
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Country | US
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Telephone | 847-982-5822
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 N DRYDEN AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4919
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Country | US
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Telephone | 847-715-6276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056013437
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License Number State | IL
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