Provider Demographics
NPI:1982655676
Name:SWIERC, SUSAN F (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:SWIERC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BANK ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4407
Mailing Address - Country:US
Mailing Address - Phone:406-549-7325
Mailing Address - Fax:406-549-7559
Practice Address - Street 1:125 BANK ST
Practice Address - Street 2:SUITE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4407
Practice Address - Country:US
Practice Address - Phone:406-549-7325
Practice Address - Fax:406-549-7559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT342103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0061997Medicaid
MT52691OtherBCBS