Provider Demographics
NPI:1851112296
Name:SWENSON, NICOLETTE CAIA
Entity type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:CAIA
Last Name:SWENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICKLAUS
Other - Middle Name:CRAIG
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7440 N JUDSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6113
Mailing Address - Country:US
Mailing Address - Phone:619-647-3700
Mailing Address - Fax:
Practice Address - Street 1:3878 RUFFIN RD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1842
Practice Address - Country:US
Practice Address - Phone:619-795-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician