Provider Demographics
NPI:1356529754
Name:SWAN, SHAY LYNN (MS QMHP)
Entity type:Individual
Prefix:
First Name:SHAY
Middle Name:LYNN
Last Name:SWAN
Suffix:
Gender:F
Credentials:MS QMHP
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:
Other - Last Name:FARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9230 MANEESE LN
Mailing Address - Street 2:
Mailing Address - City:GOREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62939-3612
Mailing Address - Country:US
Mailing Address - Phone:618-713-2256
Mailing Address - Fax:
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:618-658-2611
Practice Address - Fax:618-658-2501
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor