Provider Demographics
NPI:1659520039
Name:SWAN, LINDSAY
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W OTTOWA
Mailing Address - Street 2:P.O BOX 162
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957
Mailing Address - Country:US
Mailing Address - Phone:217-379-4302
Mailing Address - Fax:217-379-4304
Practice Address - Street 1:1510 W OTTOWA
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:IL
Practice Address - Zip Code:60957
Practice Address - Country:US
Practice Address - Phone:217-379-4302
Practice Address - Fax:217-379-4304
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator