Provider Demographics
NPI:1932609070
Name:SWANSON, SAMANTHA J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:J
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:61238-1159
Mailing Address - Country:US
Mailing Address - Phone:309-507-1896
Mailing Address - Fax:
Practice Address - Street 1:126 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:IL
Practice Address - Zip Code:61238-1159
Practice Address - Country:US
Practice Address - Phone:309-507-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health