Provider Demographics
NPI:1548403462
Name:SWAN, MARTHA SUZANNE (SLP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SUZANNE
Last Name:SWAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5407
Mailing Address - Country:US
Mailing Address - Phone:678-431-9065
Mailing Address - Fax:
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD
Practice Address - Street 2:BUILDING G
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3035
Practice Address - Country:US
Practice Address - Phone:770-622-2532
Practice Address - Fax:770-622-2534
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006969235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist