Provider Demographics
NPI:1003526633
Name:SWANN, KATHRYN EMILY (BCBA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:EMILY
Last Name:SWANN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 W GRANT RANCH BLVD APT 615
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2650
Mailing Address - Country:US
Mailing Address - Phone:850-454-9467
Mailing Address - Fax:
Practice Address - Street 1:2525 S WADSWORTH BLVD STE 106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3246
Practice Address - Country:US
Practice Address - Phone:720-962-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-22-62323103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst