Healthcare Provider Details

I. General information

NPI: 1821302134
Provider Name (Legal Business Name): GARRY CHARLES SWIFT LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 CHAGRIN BLVD STE 320
SHAKER HEIGHTS OH
44122-5334
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-7239
  • Fax: 216-295-7240
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0013049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: