Provider Demographics
NPI:1689693111
Name:SWARTZ, MICHAEL THOMAS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13750 86TH TER
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-8830
Mailing Address - Country:US
Mailing Address - Phone:386-364-6426
Mailing Address - Fax:386-364-1433
Practice Address - Street 1:13750 86TH TER
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-8830
Practice Address - Country:US
Practice Address - Phone:386-364-6426
Practice Address - Fax:386-364-1433
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884630800Medicaid