Provider Demographics
NPI:1942453626
Name:SWENSON, JENNI LYN (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:JENNI
Middle Name:LYN
Last Name:SWENSON
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4827
Mailing Address - Country:US
Mailing Address - Phone:505-927-6011
Mailing Address - Fax:
Practice Address - Street 1:2220 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4827
Practice Address - Country:US
Practice Address - Phone:505-927-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0135131101YM0800X
NM0158061101YM0800X
AZLPC-17322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85521876Medicaid