Active NPI
Samantha Jean Rivera, M.S. CCC-SLP
- Speech-Language Pathologist
- Grand Rapids, MI
National Provider Identifier
1033420740
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12132343
- Practice address
- 1490 E Beltline Ave SE
Grand Rapids, MI 49506-4336 - Phone
- (269) 492-7842
- Fax
- (269) 492-7844
- NPI assigned
- Jun 28, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12132343 | MI | Primary |
Addresses
Primary practice location
1490 E Beltline Ave SE
Grand Rapids, MI 49506-4336
Mailing address
Meddac-Bavaria
CMR
Apo, AE 09112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12132343 | MI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701993600000",
"number": "1033420740",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "MEDDAC-BAVARIA",
"address_2": "CMR",
"city": "APO",
"state": "AE",
"postal_code": "09112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1490 E BELTLINE AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495064336",
"telephone_number": "269-492-7842",
"fax_number": "269-492-7844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "SAMANTHA",
"middle_name": "JEAN",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-28",
"last_updated": "2023-12-08",
"certification_date": "2023-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MI",
"license": "12132343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.