Provider Demographics
NPI:1497248942
Name:SWACKER, TESSA MARIE
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:MARIE
Last Name:SWACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:CADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1539
Mailing Address - Country:US
Mailing Address - Phone:515-697-5700
Mailing Address - Fax:
Practice Address - Street 1:620 8TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1539
Practice Address - Country:US
Practice Address - Phone:515-697-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-10
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY5011232171M00000X
IAT22164101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY5011232OtherDRIVER'S LICENSE