Provider Demographics
NPI:1609090901
Name:SWAN, DONALD W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:SWAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SW GRIFFITH DR
Mailing Address - Street 2:STE 161
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-5607
Mailing Address - Country:US
Mailing Address - Phone:503-641-4546
Mailing Address - Fax:
Practice Address - Street 1:4900 SW GRIFFITH DR
Practice Address - Street 2:STE 161
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-5607
Practice Address - Country:US
Practice Address - Phone:503-641-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical