Provider Demographics
NPI:1033212394
Name:SWIFT, IDA S (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:IDA
Middle Name:S
Last Name:SWIFT
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 HERITAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-5713
Mailing Address - Country:US
Mailing Address - Phone:334-727-7489
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL ROAD
Practice Address - Street 2:BLDG. 4 ROOM 303
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1544G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical