Provider Demographics
NPI:1366329252
Name:SWANN, RANDALL
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:SWANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1778 MCGOWAN PKWY
Mailing Address - Street 2:
Mailing Address - City:OLIVEHURST
Mailing Address - State:CA
Mailing Address - Zip Code:95961-4745
Mailing Address - Country:US
Mailing Address - Phone:530-741-6191
Mailing Address - Fax:
Practice Address - Street 1:1778 MCGOWAN PKWY
Practice Address - Street 2:
Practice Address - City:OLIVEHURST
Practice Address - State:CA
Practice Address - Zip Code:95961-4745
Practice Address - Country:US
Practice Address - Phone:530-277-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool