Provider Demographics
NPI:1811153166
Name:SWAIN, MICHELE DIMON (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:DIMON
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-1419
Mailing Address - Country:US
Mailing Address - Phone:518-461-7033
Mailing Address - Fax:
Practice Address - Street 1:611 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-1419
Practice Address - Country:US
Practice Address - Phone:518-461-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007445-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist