Provider Demographics
NPI:1902463177
Name:SWANN, CHRISTIE ALENE (VI)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:ALENE
Last Name:SWANN
Suffix:
Gender:F
Credentials:VI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-1828
Mailing Address - Country:US
Mailing Address - Phone:270-210-7516
Mailing Address - Fax:
Practice Address - Street 1:1309 OLIVE ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1828
Practice Address - Country:US
Practice Address - Phone:270-210-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist