Provider Demographics
NPI:1194845099
Name:SWANN, KATHYN ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:KATHYN
Middle Name:ELIZABETH
Last Name:SWANN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-5406
Mailing Address - Country:US
Mailing Address - Phone:406-723-6609
Mailing Address - Fax:
Practice Address - Street 1:1820 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-5406
Practice Address - Country:US
Practice Address - Phone:406-723-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT98171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist