Provider Demographics
NPI:1447739040
Name:SWANSON, JEWEL (PLMHP)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-0355
Mailing Address - Country:US
Mailing Address - Phone:402-494-3337
Mailing Address - Fax:402-494-3356
Practice Address - Street 1:221 W DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763
Practice Address - Country:US
Practice Address - Phone:402-336-2800
Practice Address - Fax:402-336-2849
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11575101YM0800X
NE7265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health