Provider Demographics
NPI:1639243686
Name:SWANSON, ANN E (MFT 8921)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MFT 8921
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 WARNER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3244
Mailing Address - Country:US
Mailing Address - Phone:619-222-8141
Mailing Address - Fax:619-222-9642
Practice Address - Street 1:1267 ROSECRANS ST STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2692
Practice Address - Country:US
Practice Address - Phone:619-222-8141
Practice Address - Fax:619-222-9642
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 8921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist