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NPI Code Detail

MEDICARE: MS. SHELLEY SWANSON MA, CCCSLPL

MEDICARE: MS. SHELLEY SWANSON MA, CCCSLPL
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
1235Z00000XSpeech-Language PathologistIL

General Provider Information

NPI Number : 1265589709
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHELLEY SWANSON MA, CCCSLPL
Provider Business Mailing Address
First Line : 2S429 WHITE BIRCH LN
Second Line :
City : WHEATON
State : IL
Zip : 60187-7932
Country : US
Telephone Number : 630-668-0748
Fax Number : 630-444-0077
Provider Business Practice Location Address
First Line : 40W310 LAFOX RD UNIT A1
Second Line :
City : ST CHARLES
State : IL
Zip : 60175-6591
Country : US
Telephone Number : 630-444-0077
Fax Number : 630-444-0077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 07/08/2007

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