Provider Demographics
NPI:1780487355
Name:SWYGART, REBECCA MARIE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:SWYGART
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST RUDISILL BLVD
Mailing Address - Street 2:SUITE 100 B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 EAST RUDISILL BLVD
Practice Address - Street 2:SUITE 100 B
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806
Practice Address - Country:US
Practice Address - Phone:260-255-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician