Individual
NICOLE SWANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1312 SW WASHINGTON ST, PORTLAND, OR 97205-2327
(503) 535-1151
(503) 535-1190
Mailing address
1312 SW WASHINGTON ST, PORTLAND, OR 97205-2327
(503) 535-1151
(503) 535-1190
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
VN246897
CA
324500000X
Substance Abuse Rehabilitation Facility
Primary
201030354LPN
OR
Other
Enumeration date
02/22/2010
Last updated
10/08/2010
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