Provider Demographics
NPI:1033390034
Name:SWANER, SUSAN TERESA
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:TERESA
Last Name:SWANER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:TERESA
Other - Last Name:STEFFEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 COTTONWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:WEST
Mailing Address - State:TX
Mailing Address - Zip Code:76691
Mailing Address - Country:US
Mailing Address - Phone:254-981-2200
Mailing Address - Fax:
Practice Address - Street 1:825 COTTONWOOD DR.
Practice Address - Street 2:
Practice Address - City:WEST
Practice Address - State:TX
Practice Address - Zip Code:76691
Practice Address - Country:US
Practice Address - Phone:254-981-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-18
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187820901Medicaid
TX1033390034Medicaid