Provider Demographics
NPI:1982194064
Name:SWICORD, LAURA (BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SWICORD
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 UNDERWOOD AVE APT 508A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8858
Mailing Address - Country:US
Mailing Address - Phone:334-596-6912
Mailing Address - Fax:
Practice Address - Street 1:757 COWAN DR
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-7409
Practice Address - Country:US
Practice Address - Phone:615-800-8180
Practice Address - Fax:678-899-6333
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-19-37220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty