Provider Demographics
NPI:1922530146
Name:SWANSON, LEE (PLADC)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 S 43RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2802
Mailing Address - Country:US
Mailing Address - Phone:402-504-3242
Mailing Address - Fax:402-504-3882
Practice Address - Street 1:1941 S 42ND ST STE 528
Practice Address - Street 2:NULL
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2996
Practice Address - Country:US
Practice Address - Phone:402-504-3242
Practice Address - Fax:402-504-3882
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1440101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)