Provider Demographics
NPI:1891970703
Name:SUSAN E SWANN PH.D. PC
Entity Type:Organization
Organization Name:SUSAN E SWANN PH.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:928-214-0922
Mailing Address - Street 1:305 E CHERRY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4626
Mailing Address - Country:US
Mailing Address - Phone:928-214-0922
Mailing Address - Fax:928-214-0915
Practice Address - Street 1:305 E CHERRY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4626
Practice Address - Country:US
Practice Address - Phone:928-214-0922
Practice Address - Fax:928-214-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1520103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104644Medicare PIN