Provider Demographics
NPI:1588665558
Name:SWAIN, SUSAN M (MAUD, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:SWAIN
Suffix:
Gender:F
Credentials:MAUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4529
Mailing Address - Country:US
Mailing Address - Phone:912-816-4153
Mailing Address - Fax:
Practice Address - Street 1:1402 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4529
Practice Address - Country:US
Practice Address - Phone:128-164-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3262231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000690885EMedicaid
GAR96119Medicare UPIN