Provider Demographics
NPI:1275838203
Name:SWANK, SUSAN ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:SWANK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 N SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4524
Mailing Address - Country:US
Mailing Address - Phone:719-439-5683
Mailing Address - Fax:719-255-3302
Practice Address - Street 1:3225 TEMPLETON GAP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8728
Practice Address - Country:US
Practice Address - Phone:719-439-5683
Practice Address - Fax:719-352-3827
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-23
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist