Provider Demographics
NPI:1184029449
Name:SWANN, SARA (HCP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:SWANN
Suffix:
Gender:F
Credentials:HCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2533
Mailing Address - Country:US
Mailing Address - Phone:304-342-3300
Mailing Address - Fax:513-332-9248
Practice Address - Street 1:1526 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2533
Practice Address - Country:US
Practice Address - Phone:304-342-3300
Practice Address - Fax:513-332-9248
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV941237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist