Provider Demographics
NPI:1760620504
Name:SWANSON, L KATHLEEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:KATHLEEN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SE BARRINGTON DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3200
Mailing Address - Country:US
Mailing Address - Phone:360-672-1772
Mailing Address - Fax:
Practice Address - Street 1:231 SE BARRINGTON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3200
Practice Address - Country:US
Practice Address - Phone:360-672-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60060689103TB0200X, 103TC0700X, 103TF0000X, 103TF0200X, 103TH0100X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy