Provider Demographics
NPI:1467572636
Name:SWAN, ANN MARIE (MA, LLP, CAAC)
Entity Type:Individual
Prefix:MISS
First Name:ANN
Middle Name:MARIE
Last Name:SWAN
Suffix:
Gender:F
Credentials:MA, LLP, CAAC
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 428
Mailing Address - Street 2:1555 INDUSTRIAL DR.
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-0428
Mailing Address - Country:US
Mailing Address - Phone:989-723-6791
Mailing Address - Fax:989-725-5061
Practice Address - Street 1:1555 INDUSTRIAL DR
Practice Address - Street 2:SCCMHA
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9775
Practice Address - Country:US
Practice Address - Phone:989-723-6791
Practice Address - Fax:989-725-5061
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101357101YA0400X
MI6301008819103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)