Provider Demographics
NPI:1780110569
Name:SWANER, JULIE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SWANER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:AMBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1630 E KINZI CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8377
Mailing Address - Country:US
Mailing Address - Phone:254-644-4070
Mailing Address - Fax:
Practice Address - Street 1:12350 INDUSTRY WAY STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4301
Practice Address - Country:US
Practice Address - Phone:907-301-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK120122235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist