Provider Demographics
NPI:1629827936
Name:SWANN, LANEY JANE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LANEY
Middle Name:JANE
Last Name:SWANN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:LANEY
Other - Middle Name:JANE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1875 CENTURY BLVD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3314
Mailing Address - Country:US
Mailing Address - Phone:404-633-8911
Mailing Address - Fax:
Practice Address - Street 1:277 MARTIN LUTHER KING JR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3476
Practice Address - Country:US
Practice Address - Phone:478-741-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist