Provider Demographics
NPI:1932263472
Name:SWAIN, ROBERTA ELLEN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:ELLEN
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:SWAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:W3024 RIM ROCK RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-8631
Mailing Address - Country:US
Mailing Address - Phone:715-835-8247
Mailing Address - Fax:
Practice Address - Street 1:W3024 RIM ROCK RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8631
Practice Address - Country:US
Practice Address - Phone:715-835-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional