Provider Demographics
NPI:1104869270
Name:SWANSON, MARY E (HIS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:SWANSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HIS
Mailing Address - Street 1:2401 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-3126
Mailing Address - Country:US
Mailing Address - Phone:440-964-2244
Mailing Address - Fax:440-964-6169
Practice Address - Street 1:2401 WEST AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3126
Practice Address - Country:US
Practice Address - Phone:440-964-2244
Practice Address - Fax:440-964-6169
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02378237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist