Provider Demographics
NPI:1033568977
Name:SWADDELL, JOAN BERNADETTE (MA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BERNADETTE
Last Name:SWADDELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:BERNADETTE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-0313
Mailing Address - Country:US
Mailing Address - Phone:671-969-8813
Mailing Address - Fax:671-734-2442
Practice Address - Street 1:185 AFAME RD
Practice Address - Street 2:
Practice Address - City:SINAJANA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-969-8813
Practice Address - Fax:671-734-2442
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULPC-037101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional