MEDICARE: MRS. TIESHA JACQUEL SWANIER B.S., SLP- ASSISTANT

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	2355S0801X	Speech-Language Assistant	39391	TX

General Provider Information

NPI Number	:	1689156317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIESHA JACQUEL SWANIER B.S., SLP- ASSISTANT

Provider Business Mailing Address
First Line	:	101 SUMMIT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-2618
Country	:	US
Telephone Number	:	682-730-0004
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 W RISINGER RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2346
Country	:	US
Telephone Number	:	817-360-5150
Fax Number	:

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	10/17/2018

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