Provider Demographics
NPI:1528103991
Name:SWARDSTROM, HANNA R (RN,LICSW)
Entity type:Individual
Prefix:MS
First Name:HANNA
Middle Name:R
Last Name:SWARDSTROM
Suffix:
Gender:F
Credentials:RN,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1221
Mailing Address - Country:US
Mailing Address - Phone:425-353-5915
Mailing Address - Fax:
Practice Address - Street 1:5010 SOUND AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-1221
Practice Address - Country:US
Practice Address - Phone:425-353-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health