Provider Demographics
NPI:1245478742
Name:SWALLOW, SUSANNE SCOTT (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:SCOTT
Last Name:SWALLOW
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2495
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-2495
Mailing Address - Country:US
Mailing Address - Phone:530-584-2388
Mailing Address - Fax:530-581-1237
Practice Address - Street 1:8762 NORTH LAKE BLVD.
Practice Address - Street 2:
Practice Address - City:KINGS BEACH
Practice Address - State:CA
Practice Address - Zip Code:96143
Practice Address - Country:US
Practice Address - Phone:530-546-9161
Practice Address - Fax:530-581-1237
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM146176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife