Provider Demographics
NPI:1396256848
Name:SWINGLE, SHANNON LEIGH (SLP CF)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:SWINGLE
Suffix:
Gender:F
Credentials:SLP CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4738 HAVEN LAKE RD APT F
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2810
Mailing Address - Country:US
Mailing Address - Phone:317-522-7058
Mailing Address - Fax:
Practice Address - Street 1:2640 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-2272
Practice Address - Country:US
Practice Address - Phone:317-923-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist