Provider Demographics
NPI:1104885995
Name:WALLINGFORD-SWARTHMORE SD
Entity type:Organization
Organization Name:WALLINGFORD-SWARTHMORE SD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:VANLANGEVELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-892-3470
Mailing Address - Street 1:200 SOUTH PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-3817
Mailing Address - Country:US
Mailing Address - Phone:610-892-3470
Mailing Address - Fax:610-480-3827
Practice Address - Street 1:200 SOUTH PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-3817
Practice Address - Country:US
Practice Address - Phone:610-892-3470
Practice Address - Fax:610-480-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001322L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014520300001Medicaid