Provider Demographics
NPI:1811791528
Name:SWANSON, SARAH L
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:L
Last Name:SWANSON
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 1:590 HAMLIN DR
Mailing Address - Street 2:
Mailing Address - City:CANYONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97417-8701
Mailing Address - Country:US
Mailing Address - Phone:530-515-1297
Mailing Address - Fax:
Practice Address - Street 1:590 HAMLIN DR
Practice Address - Street 2:
Practice Address - City:CANYONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97417-8701
Practice Address - Country:US
Practice Address - Phone:530-515-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111956172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker