Provider Demographics
NPI:1275186199
Name:SWENSON, SAVANNAH JANE (ACSM-EP)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JANE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:ACSM-EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 SUN VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-7061
Mailing Address - Country:US
Mailing Address - Phone:605-353-5811
Mailing Address - Fax:
Practice Address - Street 1:709 SUN VALLEY ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-7061
Practice Address - Country:US
Practice Address - Phone:605-353-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer