Raenise Sampson, MA-CCC, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0001945 Issued in CO

Practice address

411 Lakewood Cir
B 119
Colorado Springs, CO 80910-2617

Phone

(719) 332-4689

NPI assigned

Apr 2, 2015

Last updated

Mar 17, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458172800000",
    "number": "1407241789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 LAKEWOOD CIR",
            "address_2": "STE A104",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809102667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 LAKEWOOD CIR",
            "address_2": "B 119",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809102617",
            "telephone_number": "719-332-4689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPSON",
        "first_name": "RAENISE",
        "credential": "MA-CCC, SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-02",
        "last_updated": "2016-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "0001945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kristin Weaver Samuelson, PHD

• Speech-Language Pathologist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Speech-Language Pathologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.