Provider Demographics
NPI:1417688045
Name:SWANKE, JAYME RAE (PHD, MSW, CADC)
Entity Type:Individual
Prefix:DR
First Name:JAYME
Middle Name:RAE
Last Name:SWANKE
Suffix:
Gender:F
Credentials:PHD, MSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4297
Mailing Address - Country:US
Mailing Address - Phone:618-214-8342
Mailing Address - Fax:
Practice Address - Street 1:360 E LAKE DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-4297
Practice Address - Country:US
Practice Address - Phone:618-214-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)