Provider Demographics
NPI:1811968670
Name:SWANSON, AMY (MS, CGC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10325 W PLUM TREE CIR
Mailing Address - Street 2:#101
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2678
Mailing Address - Country:US
Mailing Address - Phone:414-805-9018
Mailing Address - Fax:414-805-9000
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-9018
Practice Address - Fax:414-805-9000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS