Basic Information
| Provider Information | |||||||||
| NPI: | 1457563173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWOBODA | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FAAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | W142N7336 OAKWOOD DR | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530514656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622555326 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10945 N PORT WASHINGTON RD | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | MEQUON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530925078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622418000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 05/05/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 205-156 | WI | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.