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General NPI Number Information
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NPI Number | 1891970703
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Entity Type | Organization
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Legal Business Name | SUSAN E SWANN PH.D. PC
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 305 E CHERRY AVE SUITE 200
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4626
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Country | US
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Telephone | 928-214-0922
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Fax | 928-214-0915
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Provider Business Mailing Address
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Address Line | 305 E CHERRY AVE SUITE 200
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4626
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Country | US
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Telephone | 928-214-0922
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Fax | 928-214-0915
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN ELIZABETH SWANN
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Credential | PH.D
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Telephone | 928-214-0922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1520
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License Number State | AZ
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