Provider Demographics
NPI:1215717236
Name:SWIFT, SUZANNE HOUSE (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:HOUSE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S AVENUE K # 3
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7401
Mailing Address - Country:US
Mailing Address - Phone:575-562-2724
Mailing Address - Fax:
Practice Address - Street 1:1500 S AVENUE K # 3
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-7401
Practice Address - Country:US
Practice Address - Phone:575-562-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist