Provider Demographics
NPI:1255756581
Name:SWADRON, REVA CHANA
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:CHANA
Last Name:SWADRON
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 1:2416 LAURELHURST RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4671
Mailing Address - Country:US
Mailing Address - Phone:216-691-6970
Mailing Address - Fax:
Practice Address - Street 1:1111 SUPERIOR AVE E STE 1800
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2500
Practice Address - Country:US
Practice Address - Phone:216-838-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4864247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist