Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2054 | IA |
NPI | 1205237641 |
---|---|
Provider Name | Dr. Richard Swanson |
First Address | Burlington, IA 52601-2623 |
Second Address | Burlington, IA 52601-2623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 04/09/2014 |