Provider Demographics
NPI:1659104420
Name:SWANSON, CARYN
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARYN
Other - Middle Name:
Other - Last Name:RYNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31 E SHERIDAN PL
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2652
Mailing Address - Country:US
Mailing Address - Phone:847-234-9407
Mailing Address - Fax:
Practice Address - Street 1:31 E SHERIDAN PL
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2652
Practice Address - Country:US
Practice Address - Phone:847-234-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1879216103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool