Provider Demographics
NPI:1639489073
Name:SWANSON, CARRIE A
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 W HIGGINS RD STE 895
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7228
Mailing Address - Country:US
Mailing Address - Phone:847-843-1900
Mailing Address - Fax:847-843-1901
Practice Address - Street 1:113 E LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1144
Practice Address - Country:US
Practice Address - Phone:630-307-0480
Practice Address - Fax:630-307-0459
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist