Active NPI
Dylan Swanson
- Behavior Technician
- Pueblo, CO
National Provider Identifier
1528653441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 21-150544
- Practice address
- 3960 Ivywood LN
Pueblo, CO 81005-2567 - Phone
- (719) 565-1276
- Fax
- (719) 565-2313
- NPI assigned
- Mar 2, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 21-150544 | CO | Primary |
Addresses
Primary practice location
3960 Ivywood LN
Pueblo, CO 81005-2567
Mailing address
3960 Ivywood LN
Pueblo, CO 81005-2567
Phone (719) 565-1276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21-150544 | CO | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614643200000",
"number": "1528653441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3960 IVYWOOD LN",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810052567",
"telephone_number": "719-565-1276",
"fax_number": "719-565-2313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3960 IVYWOOD LN",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810052567",
"telephone_number": "719-565-1276",
"fax_number": "719-565-2313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWANSON",
"first_name": "DYLAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-02",
"last_updated": "2021-03-02",
"certification_date": "2021-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CO",
"license": "21-150544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.