Provider Demographics
NPI:1043431877
Name:SWIFT, TERESA ANN (MA CCC, SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:SWIFT
Suffix:
Gender:F
Credentials:MA CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 HATCHER PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8848
Mailing Address - Country:US
Mailing Address - Phone:260-482-4870
Mailing Address - Fax:260-482-4870
Practice Address - Street 1:4330 HATCHER PASS
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8848
Practice Address - Country:US
Practice Address - Phone:260-482-4870
Practice Address - Fax:260-482-4870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003579A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20722360OtherIHCP PROVIDER NUMBER