Provider Demographics
NPI:1336702323
Name:SWAIN, TERESA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3602
Mailing Address - Country:US
Mailing Address - Phone:419-281-6293
Mailing Address - Fax:
Practice Address - Street 1:663 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3602
Practice Address - Country:US
Practice Address - Phone:419-281-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.3795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered