Provider Demographics
NPI:1679734917
Name:SWANSON, VICTORIA COOPER (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:COOPER
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80966
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0966
Mailing Address - Country:US
Mailing Address - Phone:337-232-4160
Mailing Address - Fax:337-232-1688
Practice Address - Street 1:200 KINGS COVE CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-0216
Practice Address - Country:US
Practice Address - Phone:337-232-4160
Practice Address - Fax:337-232-1688
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA864103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities