Provider Demographics
NPI:1184137283
Name:SWENSON, GAIL MARY
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:MARY
Last Name:SWENSON
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 1:3125 CHANCERY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-1726
Mailing Address - Country:US
Mailing Address - Phone:815-398-4878
Mailing Address - Fax:
Practice Address - Street 1:730 LINCOLN PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-1429
Practice Address - Country:US
Practice Address - Phone:815-490-5410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1895047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist