Provider Demographics
NPI:1891475232
Name:SWANSON, KAYLA MARIE (MS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S RIDGEWOOD AVE STE 32
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3073
Mailing Address - Country:US
Mailing Address - Phone:850-570-0420
Mailing Address - Fax:
Practice Address - Street 1:31 N UNIVERSITY CIR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3682
Practice Address - Country:US
Practice Address - Phone:850-570-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health