Provider Demographics
NPI:1114256880
Name:SWANSON, DEBRA LEE (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 ROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16371-1605
Mailing Address - Country:US
Mailing Address - Phone:811-563-6412
Mailing Address - Fax:
Practice Address - Street 1:709 ROUSE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16371-1605
Practice Address - Country:US
Practice Address - Phone:811-563-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003766L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist