Provider Demographics
NPI:1770086381
Name:SWANSON, KIM NAOMI (RBT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:NAOMI
Last Name:SWANSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 MERRILL DR APT 53
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7166
Mailing Address - Country:US
Mailing Address - Phone:424-558-8482
Mailing Address - Fax:
Practice Address - Street 1:6515 SANDY POINT CT
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5871
Practice Address - Country:US
Practice Address - Phone:818-437-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician