Provider Demographics
NPI:1134392558
Name:SWAIN, JENNIFER E (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 NEWMANS CARDINGTON RD W
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:OH
Mailing Address - Zip Code:43342-9787
Mailing Address - Country:US
Mailing Address - Phone:740-262-6510
Mailing Address - Fax:
Practice Address - Street 1:2595 NEWMANS CARDINGTON RD W
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:OH
Practice Address - Zip Code:43342-9787
Practice Address - Country:US
Practice Address - Phone:740-262-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5933103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical