Provider Demographics
NPI:1407437338
Name:SWANK, TEASHA (LLMSW)
Entity Type:Individual
Prefix:
First Name:TEASHA
Middle Name:
Last Name:SWANK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3647 URBAN DEPOT CT
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1008
Mailing Address - Country:US
Mailing Address - Phone:269-275-4241
Mailing Address - Fax:
Practice Address - Street 1:3315 GREENLEAF BLVD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2516
Practice Address - Country:US
Practice Address - Phone:269-281-3886
Practice Address - Fax:269-390-3117
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851107344104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker