Provider Demographics
NPI:1326879487
Name:SWAN, SARA JANE (MS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JANE
Last Name:SWAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2035
Mailing Address - Country:US
Mailing Address - Phone:309-826-0833
Mailing Address - Fax:
Practice Address - Street 1:332 W SUPERIOR ST STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1844
Practice Address - Country:US
Practice Address - Phone:218-722-4379
Practice Address - Fax:218-722-4333
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional