| Swan Therapeutic Services, Llc | |
|
7001 Blue Ridge Blvd Raytown MO 64133-5629 | |
| (816) 966-0900 | |
| (816) 347-3029 |
| Full Name | Swan Therapeutic Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 7001 Blue Ridge Blvd, Raytown, Missouri |
| Authorized Official Name and Position | Kristin Anne Coblentz Swan (OWNER) |
| Authorized Official Contact | 8165813737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Swan Therapeutic Services, Llc 529 Se 2nd St Ste D Lees Summit MO 64063-2654 Ph: (816) 581-3737 | Swan Therapeutic Services, Llc 7001 Blue Ridge Blvd Raytown MO 64133-5629 Ph: (816) 966-0900 |
| NPI Number | 1912247214 |
|---|---|
| Provider Enumeration Date | 02/22/2013 |
| Last Update Date | 12/06/2022 |
| Certification Date | 12/06/2022 |
| Medicare PECOS PAC ID | 4486891090 |
|---|---|
| Medicare Enrollment ID | O20130517000515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912247214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2004032834 (Missouri) | Primary |
| Provider Name | Kristin A Coblentz Swan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407987662 PECOS PAC ID: 1557421542 Enrollment ID: I20081120000557 |
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