Basic Information
Provider Information
NPI: 1023335478
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCSWIGAN
FirstName: JOHN
MiddleName: DAVID
NamePrefix:  
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 971 SW WALNUT ST
Address2:  
City: HILLSBORO
State: OR
PostalCode: 971235651
CountryCode: US
TelephoneNumber: 5036405297
FaxNumber: 5036405780
Practice Location
Address1: 971 SW WALNUT ST
Address2:  
City: HILLSBORO
State: OR
PostalCode: 971235651
CountryCode: US
TelephoneNumber: 5036405297
FaxNumber: 5036405780
Other Information
ProviderEnumerationDate: 04/26/2010
LastUpdateDate: 04/26/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X  Y Behavioral Health & Social Service ProvidersPsychologist 

No ID Information.


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