Provider Demographics
NPI:1043201874
Name:SWANSTROM, GAIL JOANNE (AUD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:JOANNE
Last Name:SWANSTROM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SE. OAK ST.
Mailing Address - Street 2:#201
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4287
Mailing Address - Country:US
Mailing Address - Phone:503-648-8971
Mailing Address - Fax:503-640-6461
Practice Address - Street 1:900 SE OAK ST.
Practice Address - Street 2:#201
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4287
Practice Address - Country:US
Practice Address - Phone:503-648-8971
Practice Address - Fax:503-640-6461
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20535231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR196253Medicaid
0000VGBGJMedicare ID - Type Unspecified