Healthcare Provider Details

I. General information

NPI: 1770407587
Provider Name (Legal Business Name): EMILY SWIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 PRIMROSE CT
WHEATFIELD IN
46392-7482
US

IV. Provider business mailing address

11515 PRIMROSE CT
WHEATFIELD IN
46392-7482
US

V. Phone/Fax

Practice location:
  • Phone: 219-869-9686
  • Fax:
Mailing address:
  • Phone: 219-869-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22009041A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: