Active NPI
Priscilla Samuelson
- Speech-Language Pathologist
- Las Vegas, NV
National Provider Identifier
1336623669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP-4335
- Practice address
- 3920 W Charleston Blvd Ste Y
Las Vegas, NV 89102-1633 - Phone
- (877) 757-8353
- Fax
- (818) 357-2505
- NPI assigned
- Sep 21, 2018
- Last updated
- Oct 7, 2026
- 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 | SP-4335 | NV | Primary |
Addresses
Primary practice location
3920 W Charleston Blvd Ste Y
Las Vegas, NV 89102-1633
Mailing address
15316 Huebner Rd Ste 202
San Antonio, TX 78248-0994
Phone (210) 614-4567
Other practice location 1
1306 E Calvada Blvd
Pahrump, NV 89048-2797
Phone (877) 757-8353
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 |
|---|---|---|---|
| 115071 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1791331200000",
"number": "1336623669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15316 HUEBNER RD STE 202",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782480994",
"telephone_number": "210-614-4567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3920 W CHARLESTON BLVD STE Y",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891021633",
"telephone_number": "877-757-8353",
"fax_number": "818-357-2505"
}
],
"practiceLocations": [
{
"address_1": "1306 E Calvada Blvd",
"address_purpose": "LOCATION",
"city": "Pahrump",
"state": "NV",
"postal_code": "890482797",
"country_code": "US",
"telephone_number": "877-757-8353",
"fax_number": "818-357-2505",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SAMUELSON",
"first_name": "PRISCILLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-21",
"last_updated": "2026-10-07",
"certification_date": "2026-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NV",
"license": "SP-4335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.