MEDICARE: ANN E. SWANSON MFT 8921

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
1	106H00000X	Marriage & Family Therapist	MFT 8921	CA

General Provider Information

NPI Number	:	1639243686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN E. SWANSON MFT 8921

Provider Business Mailing Address
First Line	:	3611 WARNER ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-3244
Country	:	US
Telephone Number	:	619-222-8141
Fax Number	:	619-222-9642

Provider Business Practice Location Address
First Line	:	1267 ROSECRANS ST STE E
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2692
Country	:	US
Telephone Number	:	619-222-8141
Fax Number	:	619-222-9642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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