Provider Demographics
NPI:1912247214
Name:SWAN THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:SWAN THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COBLENTZ SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:816-581-3737
Mailing Address - Street 1:529 SE 2ND ST STE D
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2654
Mailing Address - Country:US
Mailing Address - Phone:816-581-3737
Mailing Address - Fax:816-581-3738
Practice Address - Street 1:7001 BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5629
Practice Address - Country:US
Practice Address - Phone:816-966-0900
Practice Address - Fax:816-347-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040328341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty