Healthcare Provider Details

I. General information

NPI: 1700024718
Provider Name (Legal Business Name): JILL E. SWANSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 STANGE RD STE. 102
AMES IA
50010-3965
US

IV. Provider business mailing address

205 W WACKER DR STE. 1020
CHICAGO IL
60606-1216
US

V. Phone/Fax

Practice location:
  • Phone: 515-956-4014
  • Fax: 515-292-7200
Mailing address:
  • Phone: 312-640-0329
  • Fax: 312-640-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004330
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: