MEDICARE: MRS. LAURA C SWAIN CAC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1483-00	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699829721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA C SWAIN CAC III

Provider Business Mailing Address
First Line	:	304 S 8TH ST
Second Line	:	SUITE 101A
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-1829
Country	:	US
Telephone Number	:	719-578-5433
Fax Number	:	719-578-5434

Provider Business Practice Location Address
First Line	:	304 S 8TH ST
Second Line	:	SUITE 101A
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-1829
Country	:	US
Telephone Number	:	719-578-5433
Fax Number	:	719-578-5434

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	09/22/2016

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