Provider Demographics
NPI:1124810577
Name:SWANSON, ELAINA ROSE (MA)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:ROSE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 SE 10TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3769
Mailing Address - Country:US
Mailing Address - Phone:253-358-0061
Mailing Address - Fax:
Practice Address - Street 1:12811 KENWOOD LN STE 202
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5646
Practice Address - Country:US
Practice Address - Phone:253-358-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health