Provider Demographics
NPI:1558162610
Name:SWANSON, PAUL DAVID (PLPC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:SWANSON
Suffix:
Gender:
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 WYOMING ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-3918
Mailing Address - Country:US
Mailing Address - Phone:515-868-8419
Mailing Address - Fax:
Practice Address - Street 1:1811 SHERMAN DR STE 3
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3976
Practice Address - Country:US
Practice Address - Phone:636-493-0016
Practice Address - Fax:888-977-3461
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025009326101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor