Provider Demographics
NPI:1689492233
Name:SWANSTROM, ADALEE
Entity type:Individual
Prefix:
First Name:ADALEE
Middle Name:
Last Name:SWANSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADALEE
Other - Middle Name:
Other - Last Name:DONAHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2065 HALF DAY RD # T-2504
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 DELAWARE RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-4699
Practice Address - Country:US
Practice Address - Phone:224-303-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.007989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist