Provider Demographics
NPI:1912302795
Name:MCSWEEN, NENA (MSSLPCCC)
Entity Type:Individual
Prefix:
First Name:NENA
Middle Name:
Last Name:MCSWEEN
Suffix:
Gender:F
Credentials:MSSLPCCC
Other - Prefix:
Other - First Name:NENA
Other - Middle Name:ETHERUDGE
Other - Last Name:MCSWEEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSSLPCCC
Mailing Address - Street 1:1000 HOLCOMB WOODS PARKWAY
Mailing Address - Street 2:STE 422
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-641-8070
Mailing Address - Fax:770-641-8078
Practice Address - Street 1:1000 HOLCOMB WOODS PARKWAY
Practice Address - Street 2:STE 422
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-641-8070
Practice Address - Fax:770-641-8078
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist