Provider Demographics
NPI:1902282254
Name:SWEDBERG, EMMA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:SWEDBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5512 WHITFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3845
Mailing Address - Country:US
Mailing Address - Phone:319-883-0606
Mailing Address - Fax:
Practice Address - Street 1:5512 WHITFIELD CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3845
Practice Address - Country:US
Practice Address - Phone:319-883-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14051603OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION (ASHA)
VA13603224OtherCAQH