Provider Demographics
NPI:1003409798
Name:SWANBERG, SARAH (SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SWANBERG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 INTELCO LOOP SE
Mailing Address - Street 2:STE B
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:360-786-1753
Mailing Address - Fax:360-786-1793
Practice Address - Street 1:4510 INTELCO LOOP SE
Practice Address - Street 2:STE B
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-786-1753
Practice Address - Fax:360-786-1793
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61135417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist