Provider Demographics
NPI:1083324347
Name:SWANSON, LEVORN VICTORIA
Entity Type:Individual
Prefix:MS
First Name:LEVORN
Middle Name:VICTORIA
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30440 WILLOW BANK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34602-7517
Mailing Address - Country:US
Mailing Address - Phone:813-580-0410
Mailing Address - Fax:
Practice Address - Street 1:30440 WILLOW BANK AVE
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-7517
Practice Address - Country:US
Practice Address - Phone:813-580-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist