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NPI Code Detail

MEDICARE: MRS. AUDRA A. SWANSON MA ED, LPCC-S, LICDC

MEDICARE: MRS. AUDRA A. SWANSON MA ED, LPCC-S, LICDC
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
1101YP2500XProfessional CounselorE2055OH
2101YM0800XMental Health Counselor991462- LICDC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11265743991OTHEROHNPI

General Provider Information

NPI Number : 1649282260
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AUDRA A. SWANSON MA ED, LPCC-S, LICDC
Provider Business Mailing Address
First Line : 4450 BELDEN VILLAGE ST NW STE 606
Second Line :
City : CANTON
State : OH
Zip : 44718-2552
Country : US
Telephone Number : 330-305-9696
Fax Number : 303-059-2923
Provider Business Practice Location Address
First Line : 4450 BELDEN VILLAGE ST NW STE 606
Second Line :
City : CANTON
State : OH
Zip : 44718-2552
Country : US
Telephone Number : 330-305-9696
Fax Number : 330-305-9292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 03/18/2021

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