Provider Demographics
NPI:1174851943
Name:SWAN, KELLI (MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 LUTHERAN PKWY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6018
Mailing Address - Country:US
Mailing Address - Phone:303-425-8191
Mailing Address - Fax:303-425-8171
Practice Address - Street 1:3655 LUTHERAN PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6018
Practice Address - Country:US
Practice Address - Phone:303-425-8191
Practice Address - Fax:303-425-8171
Is Sole Proprietor?:No
Enumeration Date:2009-12-06
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS