Provider Demographics
NPI:1316992050
Name:SWAIN, AMY C (AUDIOLOGIST)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:C
Last Name:SWAIN
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:685 W BRIDGE ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2887
Mailing Address - Country:US
Mailing Address - Phone:507-451-3879
Mailing Address - Fax:866-773-5194
Practice Address - Street 1:685 W BRIDGE ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2887
Practice Address - Country:US
Practice Address - Phone:507-451-3879
Practice Address - Fax:866-773-5194
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5460231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN187265600Medicare ID - Type Unspecified