Basic Information
| Provider Information | |||||||||
| NPI: | 1083844294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWAIN | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3948 NE 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972121133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039613921 | ||||||||
| FaxNumber: | 8665730984 | ||||||||
| Practice Location | |||||||||
| Address1: | 25117 SW PARKWAY AVE | ||||||||
| Address2: | STE. D | ||||||||
| City: | WILSONVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970709697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035703665 | ||||||||
| FaxNumber: | 5035709155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2009 | ||||||||
| LastUpdateDate: | 01/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 13252 | OR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.