Provider Demographics
NPI:1114004215
Name:SWARTZ, STACIE J
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:J
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 SNAFFLE BIT RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-8438
Mailing Address - Country:US
Mailing Address - Phone:317-796-2310
Mailing Address - Fax:317-769-5087
Practice Address - Street 1:4035 SNAFFLE BIT RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-8438
Practice Address - Country:US
Practice Address - Phone:317-796-2310
Practice Address - Fax:317-769-5087
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003019A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist