Provider Demographics
NPI:1265827265
Name:SWEZEY, SHANNA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:SWEZEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 GATEWAY LOOP STE 140
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7722
Mailing Address - Country:US
Mailing Address - Phone:541-654-8107
Mailing Address - Fax:
Practice Address - Street 1:1126 GATEWAY LOOP
Practice Address - Street 2:SUITE 140
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-654-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 372600000X
ORA5399101Y00000X, 104100000X
ORL106801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No372600000XNursing Service Related ProvidersAdult Companion