Provider Demographics
NPI:1083844294
Name:SWAIN, JACOB J (MS)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:J
Last Name:SWAIN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3948 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1133
Mailing Address - Country:US
Mailing Address - Phone:503-961-3921
Mailing Address - Fax:866-573-0984
Practice Address - Street 1:25117 SW PARKWAY AVE
Practice Address - Street 2:STE. D
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9697
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:503-570-9155
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist