Provider Demographics
NPI:1457563173
Name:SWOBODA, PHILIP JAMES (FAAA)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JAMES
Last Name:SWOBODA
Suffix:
Gender:M
Credentials:FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W142N7336 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4656
Mailing Address - Country:US
Mailing Address - Phone:262-255-5326
Mailing Address - Fax:
Practice Address - Street 1:10945 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 211
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5078
Practice Address - Country:US
Practice Address - Phone:262-241-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI205-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist