Provider Demographics
NPI:1720544711
Name:SWANSON, MICHELLE SARAH
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SARAH
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 1:14200 LAUREL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5201
Mailing Address - Country:US
Mailing Address - Phone:470-792-4717
Mailing Address - Fax:
Practice Address - Street 1:14200 LAUREL PARK DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5201
Practice Address - Country:US
Practice Address - Phone:470-792-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist