Provider Demographics
NPI:1447319397
Name:SWENSON, SHELLEY RENE (RD, CD)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:RENE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21921 40TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7983
Mailing Address - Country:US
Mailing Address - Phone:425-256-2184
Mailing Address - Fax:
Practice Address - Street 1:10808 NE 145TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5200
Practice Address - Country:US
Practice Address - Phone:425-296-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA943031133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8443624Medicaid