Provider Demographics
NPI:1528843737
Name:SWINGLE, MADELINE SHEA
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:SHEA
Last Name:SWINGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 STEPNEY DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1242
Mailing Address - Country:US
Mailing Address - Phone:571-208-7607
Mailing Address - Fax:
Practice Address - Street 1:2400 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1536
Practice Address - Country:US
Practice Address - Phone:571-208-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist