Provider Demographics
NPI:1720559115
Name:SWANSON, LAURA OLSON (MSW, ASW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:OLSON
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CONNORS CT STE C
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1177
Mailing Address - Country:US
Mailing Address - Phone:831-818-8072
Mailing Address - Fax:
Practice Address - Street 1:389 CONNORS CT STE C
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1177
Practice Address - Country:US
Practice Address - Phone:831-818-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA1043321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician