Provider Demographics
NPI:1043458797
Name:SWANSON-LEADBETTER, ANNE ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ELIZABETH
Last Name:SWANSON-LEADBETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:SWANSON
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-0841
Mailing Address - Country:US
Mailing Address - Phone:909-591-9108
Mailing Address - Fax:909-591-9103
Practice Address - Street 1:13107 CHUKAR CT
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3898
Practice Address - Country:US
Practice Address - Phone:909-591-9108
Practice Address - Fax:909-591-9103
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist