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Individual

LISA D SWAIM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA

Contact information

Practice address
21750 227TH ST, TONGANOXIE, KS 66086-4470
(913) 710-0210
Mailing address
21750 227TH ST, TONGANOXIE, KS 66086-4470
(913) 710-0210

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3019
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
12154709
ASHA
01
3019
LICSENSE
KS
01
NONE
NONE
Enumeration date
03/25/2020
Last updated
03/25/2020
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