Provider Demographics
NPI:1912546771
Name:SWANSON, ELISABETH SUE (SLP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:SUE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:NICOLETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:30 AVON MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3745
Mailing Address - Country:US
Mailing Address - Phone:860-284-9779
Mailing Address - Fax:860-409-2190
Practice Address - Street 1:30 AVON MEADOW LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3745
Practice Address - Country:US
Practice Address - Phone:860-284-9779
Practice Address - Fax:860-409-2190
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist