Individual
GWENDOLYN SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDD
Contact information
Practice address
2187 N VICKEY ST, FLAGSTAFF, AZ 86004-6106
(928) 714-6401
Mailing address
2187 N VICKEY ST, FLAGSTAFF, AZ 86004-6106
(928) 714-6401
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC0743
AZ
Other
Enumeration date
08/13/2006
Last updated
07/08/2007
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