Provider Demographics
NPI:1295263291
Name:SWANSON, ANDREA (MA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11028 KELLY RD NE
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-6904
Mailing Address - Country:US
Mailing Address - Phone:425-788-1617
Mailing Address - Fax:
Practice Address - Street 1:23525 NE NOVELTY HILL RD STE A109
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-1995
Practice Address - Country:US
Practice Address - Phone:425-868-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60712837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist