Provider Demographics
NPI:1609584549
Name:SWAGERTY, MATTHEW (SLP-CF)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SWAGERTY
Suffix:
Gender:M
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18432 SANDPIPER CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8218
Mailing Address - Country:US
Mailing Address - Phone:503-689-6454
Mailing Address - Fax:
Practice Address - Street 1:1525 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OR
Practice Address - Zip Code:97351-1007
Practice Address - Country:US
Practice Address - Phone:503-689-6454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist