Provider Demographics
NPI:1144520461
Name:SWAN, STACEY ANN (MS PLMHP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:SWAN
Suffix:
Gender:F
Credentials:MS PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-1146
Mailing Address - Country:US
Mailing Address - Phone:402-216-0561
Mailing Address - Fax:866-733-2530
Practice Address - Street 1:1700 14TH AVE
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-1146
Practice Address - Country:US
Practice Address - Phone:402-216-0561
Practice Address - Fax:866-733-2530
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9243101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor