Provider Demographics
NPI:1609077148
Name:SWISHER, WAYNE EVERETT (PHD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:EVERETT
Last Name:SWISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4626
Mailing Address - Country:US
Mailing Address - Phone:701-775-7798
Mailing Address - Fax:
Practice Address - Street 1:290 CENTENNIAL DR
Practice Address - Street 2:BOX 8040
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6063
Practice Address - Country:US
Practice Address - Phone:701-777-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist