Individual provider Active NPI

Andrea Nicole Samuel, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Anchorage, AK
National Provider Identifier
1417268558
Registry record updated Feb 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLPS116 Issued in AK
Practice address
4141 B St Ste 302
Anchorage, AK 99503-5942
Phone
(907) 887-6181
NPI assigned
Jun 23, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 116 AK
Speech-Language Pathologist 235Z00000X SLPS116 AK Primary

Addresses

Primary practice location

4141 B St Ste 302
Anchorage, AK 99503-5942

Mailing address

4141 B St Ste 302
Anchorage, AK 99503-5942
Phone (907) 887-6181

Other practice location 1

4130 Charing Cross Cir
Anchorage, AK 99504-4426
Phone (907) 887-6181

Other identifiers 1

IdentifierTypeStateIssuer
1031235MedicaidAK

Other names 1

  • Miss Andrea Nicole Patterson Former name

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
116AKMDSpeech-Language Pathologist
SLPS116AKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Connect Speech & Language, LLC Speech-Language Pathologist Current Accepting new patients

Locations

4141 B St
Ste 302
Anchorage, AK 99503
Phone (907) 770-0585

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.

NPI Registry JSON

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580774400000",
    "number": "1417268558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 B ST STE 302",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995035942",
            "telephone_number": "907-887-6181",
            "fax_number": "907-646-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 B ST STE 302",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995035942",
            "telephone_number": "907-887-6181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4130 Charing Cross Cir",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995044426",
            "country_code": "US",
            "telephone_number": "907-887-6181",
            "fax_number": "907-677-7628",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "ANDREA",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AK",
            "license": "116",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AK",
            "license": "SLPS116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1031235",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "PATTERSON",
            "middle_name": "NICOLE",
            "prefix": "MISS",
            "credential": "M.S., CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; 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.