Provider Demographics
NPI:1689357519
Name:SWANAGAN, KATIE LOUISE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LOUISE
Last Name:SWANAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LOUISE
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1264 US HIGHWAY 1 STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2746
Mailing Address - Country:US
Mailing Address - Phone:321-693-4950
Mailing Address - Fax:
Practice Address - Street 1:1264 US HIGHWAY 1 STE 103
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2746
Practice Address - Country:US
Practice Address - Phone:321-693-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker