Provider Demographics
NPI:1124807854
Name:SWIM LEARN PLAY
Entity type:Organization
Organization Name:SWIM LEARN PLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BREANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP/L
Authorized Official - Phone:828-712-2012
Mailing Address - Street 1:400 N MCCLURG CT APT 3214
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4386
Mailing Address - Country:US
Mailing Address - Phone:828-712-2012
Mailing Address - Fax:
Practice Address - Street 1:6201 JOLIET RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3958
Practice Address - Country:US
Practice Address - Phone:312-725-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1437827789OtherIMPACT
1669140331OtherIMPACT