Provider Demographics
NPI:1316082654
Name:SWENSEN, CLIFFORD HENRIK JR (PHD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:HENRIK
Last Name:SWENSEN
Suffix:JR
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1700 LINDBERG RD
Mailing Address - Street 2:APT. 229
Mailing Address - City:WEST LAFAYETTE BRA
Mailing Address - State:IN
Mailing Address - Zip Code:47906-7317
Mailing Address - Country:US
Mailing Address - Phone:765-463-6822
Mailing Address - Fax:765-464-5645
Practice Address - Street 1:1700 LINDBERG RD
Practice Address - Street 2:APT. 229
Practice Address - City:WEST LAFAYETTE BRA
Practice Address - State:IN
Practice Address - Zip Code:47906-7317
Practice Address - Country:US
Practice Address - Phone:765-463-6822
Practice Address - Fax:765-464-5645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN20010025A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical