NPIMap

Samantha Church, M.S, CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Locust, NC

NPI 1093879751 · NPPES record last updated Feb 4, 2009

Key facts

NPI
1093879751
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
7716 (NC)
Practice address
101 Creekview St
Locust, NC 28097-8507
Phone
(704) 302-4450
Fax
(704) 323-5222
NPI assigned
Dec 20, 2006
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
4157SCMDDental Hygienist
7716NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
The Therapy Station, LLC Speech-Language Pathologist Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 7716 NC Yes
Speech-Language Pathologist 235Z00000X 4157 SC

Addresses

Primary practice location

101 Creekview St
Locust, NC 28097-8507

Mailing address

101 Creekview St
Locust, NC 28097-8507
Phone (704) 302-4450

Other providers in Locust, NC

All providers in Locust, NC · Speech-Language Pathologist in North Carolina

Sources for this page

Verify at the official NPI Registry.