Provider Demographics
NPI:1578712352
Name:SWENSON, LAURIE LEE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:LEE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:LEE
Other - Last Name:STEFANIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:9 BEECHES LANE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281
Mailing Address - Country:US
Mailing Address - Phone:860-963-2209
Mailing Address - Fax:
Practice Address - Street 1:9 BEECHES LANE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281
Practice Address - Country:US
Practice Address - Phone:860-963-2209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005388225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist