Provider Demographics
NPI:1881333847
Name:SWENSON, MESTOWETE
Entity type:Individual
Prefix:MRS
First Name:MESTOWETE
Middle Name:
Last Name:SWENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20782 SAINT GEORGE CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2211
Mailing Address - Country:US
Mailing Address - Phone:503-267-6073
Mailing Address - Fax:541-317-0130
Practice Address - Street 1:20782 SAINT GEORGE CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2211
Practice Address - Country:US
Practice Address - Phone:503-267-6073
Practice Address - Fax:541-317-0130
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR519237171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator