Provider Demographics
NPI:1316590284
Name:SWART, JENNIFER (MS CFY)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SWART
Suffix:
Gender:F
Credentials:MS CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 1ST ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5281
Mailing Address - Country:US
Mailing Address - Phone:580-554-2320
Mailing Address - Fax:
Practice Address - Street 1:1451 GALWAY DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7845
Practice Address - Country:US
Practice Address - Phone:575-495-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF6836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist