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General NPI Number Information
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NPI Number | 1114729175
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Entity Type | Individual
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Provider Name | MR. NICHOLAS SWANSON
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Gender | Male
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 29226 ORCHARD LAKE RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2984
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Country | US
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Telephone | 734-985-2964
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Fax | 877-927-8461
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Provider Business Mailing Address
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Address Line | 10033 HART AVE
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1125
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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