Provider Demographics
NPI:1194863175
Name:SWARTOUT, COLLEEN M
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:SWARTOUT
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 1:4211 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6063
Mailing Address - Country:US
Mailing Address - Phone:440-993-1267
Mailing Address - Fax:440-993-1260
Practice Address - Street 1:4211 BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6063
Practice Address - Country:US
Practice Address - Phone:440-993-1267
Practice Address - Fax:440-993-1260
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2436135251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2436135OtherPROVIDER NUMBER