Provider Demographics
NPI:1346246204
Name:SWEDE, GENE A (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:A
Last Name:SWEDE
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1601
Mailing Address - Country:US
Mailing Address - Phone:507-637-3021
Mailing Address - Fax:507-637-2321
Practice Address - Street 1:109 E 2ND ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1601
Practice Address - Country:US
Practice Address - Phone:507-637-3021
Practice Address - Fax:507-637-2321
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2004237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122397OtherU-CARE/SCHAMA PROVIDER
MN171165800Medicaid
MN1A503TOOtherBLUE PLUS - MA PROVIDER