Basic Information
| Provider Information | |||||||||
| NPI: | 1780110569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWANER | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S., CF-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | AMBURN | ||||||||
| OtherFirstName: | JULIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1630 E KINZI CIR APT 4 | ||||||||
| Address2: | |||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996548377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546444070 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12350 INDUSTRY WAY STE 202 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995154301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073014588 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 120122 | AK | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.