| Doctor Name: | GARY SWAN |
| NPI Number: | 1043633159 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | 15662-131 |
| Business Practice Address: | 2607 N Grandview Blvd Suite 104 Waukesha, WI - 531881686 |
| Business Phone Number: | 2624469981 |
| Business Fax Number: | 2624469983 |
| Mailing Address: | 3900 W Brown Deer Rd, Suite 200 BROWN DEER |
| State: | WI |
| Postal Code: | 532091220 |
| Phone Number: | 4145402170 |
| Fax Number: | 4145402171 |
| NPI Enumeration Date: | 01/24/2014 |
| NPI Last Update Date: | 03/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 15662-131 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |