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General NPI Number Information
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NPI Number | 1003004664
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Entity Type | Individual
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Provider Name | ALICIA BROADWAY SWANN AUDIOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 541 HIGHWAY 80 W SUITE C
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City | CLINTON
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State | MS
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Zip | 39056-4193
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Country | US
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Telephone | 601-488-4189
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Fax | 601-488-4888
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Provider Business Mailing Address
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Address Line | 541 HIGHWAY 80 W AUDITORY PROCESSING CENTER
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City | CLINTON
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State | MS
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Zip | 39056-4193
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Country | US
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Telephone | 601-488-4189
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Fax | 601-488-4888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A0955
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License Number State | MS
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