Provider Demographics
NPI:1689249161
Name:SWENSEN, CHELTSEA J
Entity Type:Individual
Prefix:
First Name:CHELTSEA
Middle Name:J
Last Name:SWENSEN
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 1:758 CHINLE DR
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3805
Mailing Address - Country:US
Mailing Address - Phone:435-899-1061
Mailing Address - Fax:
Practice Address - Street 1:445 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3250
Practice Address - Country:US
Practice Address - Phone:435-644-4520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health