Provider Demographics
NPI:1811069990
Name:SWANSON, BILLI JAE (SLP)
Entity type:Individual
Prefix:MRS
First Name:BILLI
Middle Name:JAE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:BILLI
Other - Middle Name:JAE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216-8237
Mailing Address - Country:US
Mailing Address - Phone:055-411-1406
Mailing Address - Fax:605-541-0109
Practice Address - Street 1:8 5TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-3713
Practice Address - Country:US
Practice Address - Phone:605-753-5400
Practice Address - Fax:605-753-6208
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123POO235Z00000X
SD954-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0601260Medicaid
IA0655407Medicaid
IA0803635Medicaid
IA16U126Medicare Oscar/Certification
IA16Z381Medicare Oscar/Certification
IA0803635Medicaid
IA0601260Medicaid
IA0655407Medicaid