Provider Demographics
NPI:1376304998
Name:SWAN ADULT PEDIATRIC SPEECH THERAPY PLLC
Entity Type:Organization
Organization Name:SWAN ADULT PEDIATRIC SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SENIOR
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:917-597-6902
Mailing Address - Street 1:2769 MATTHEWS AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8625
Mailing Address - Country:US
Mailing Address - Phone:917-597-6902
Mailing Address - Fax:
Practice Address - Street 1:2769 MATTHEWS AVE APT 2D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8625
Practice Address - Country:US
Practice Address - Phone:917-597-6902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty