Provider Demographics
NPI:1659339968
Name:SWANK, CHARLES III (MS, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:SWANK
Suffix:III
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-3414
Mailing Address - Country:US
Mailing Address - Phone:513-529-2500
Mailing Address - Fax:513-529-2502
Practice Address - Street 1:301 S PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-3414
Practice Address - Country:US
Practice Address - Phone:513-529-2500
Practice Address - Fax:513-529-2502
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-A 01005231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2148787Medicaid
OH4026522Medicare ID - Type Unspecified
P09800Medicare UPIN