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NPI Code Detail

MEDICARE: MRS. JENIPHER A SWANSON MA, BCBA

MEDICARE: MRS. JENIPHER A SWANSON MA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-11-8698CA

General Provider Information

NPI Number : 1164785853
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENIPHER A SWANSON MA, BCBA
Provider Business Mailing Address
First Line : PO BOX 663
Second Line :
City : LAKELAND
State : MI
Zip : 48143-0663
Country : US
Telephone Number : 810-599-2129
Fax Number :
Provider Business Practice Location Address
First Line : 4801 MONTANO RD NW STE A2
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-2423
Country : US
Telephone Number : 505-336-0560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2012
Last Update Date : 07/05/2023

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