Active NPI
Jessica Samples
- Speech-Language Pathologist
- Coalton, WV
National Provider Identifier
1144076563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP-2461
- Practice address
- 278 Broadway Ave
Coalton, WV 26257-6708 - Phone
- (304) 636-9150
- NPI assigned
- Apr 26, 2024
- 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 | SLP-2461 | WV | Primary |
Addresses
Primary practice location
278 Broadway Ave
Coalton, WV 26257-6708
Mailing address
278 Broadway Ave
Coalton, WV 26257-6708
Phone (304) 636-9150
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP-2461 | WV | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714089600000",
"number": "1144076563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "278 BROADWAY AVE",
"city": "COALTON",
"state": "WV",
"postal_code": "262576708",
"telephone_number": "304-636-9150"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "278 BROADWAY AVE",
"city": "COALTON",
"state": "WV",
"postal_code": "262576708",
"telephone_number": "304-636-9150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMPLES",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-26",
"last_updated": "2024-04-26",
"certification_date": "2024-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WV",
"license": "SLP-2461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coalton, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.