Provider Demographics
NPI:1174551477
Name:SWENSON, STUART H (PHD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:H
Last Name:SWENSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2534
Mailing Address - Country:US
Mailing Address - Phone:877-838-4783
Mailing Address - Fax:888-617-8611
Practice Address - Street 1:2185 BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2534
Practice Address - Country:US
Practice Address - Phone:877-838-4783
Practice Address - Fax:888-617-8611
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040226A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000369664OtherANTHEM
IN100201330BMedicaid
IN680015790OtherTRI-CARE
IN197020Medicare PIN