Individual
JESSICA SWANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
TLLP
Contact information
Practice address
705 S MAIN ST STE 280, PLYMOUTH, MI 48170-1060
(734) 454-1094
Mailing address
3285 DUFFIELD ST, WHITE LAKE, MI 48383-1713
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301017249
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/26/2014
Last updated
03/17/2018
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