MEDICARE: TERESA ANN SWIFT M.A. CCC, SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22003579A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20722360	OTHER	IN	IHCP PROVIDER NUMBER

General Provider Information

NPI Number	:	1043431877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN SWIFT M.A. CCC, SLP

Provider Business Mailing Address
First Line	:	4330 HATCHER PASS
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8848
Country	:	US
Telephone Number	:	260-482-4870
Fax Number	:	260-482-4870

Provider Business Practice Location Address
First Line	:	4330 HATCHER PASS
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8848
Country	:	US
Telephone Number	:	260-482-4870
Fax Number	:	260-482-4870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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