Samantha Michelle Slack, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801093973 Issued in MI

Practice address

1440 Torrey Rd Ste E
Fenton, MI 48430

Phone

(999) 999-9999

NPI assigned

Aug 2, 2010

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

Other names 1

• Samantha Langstaff Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Fenton Therapy Services LLC

  • Psychologist
  • Fenton, MI
  • NPI 1548759541
  NPD (past)

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

{
    "created_epoch": "1280707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527120000000",
    "number": "1497069488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 TORREY RD STE E",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 TORREY RD STE E",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "48430",
            "telephone_number": "999-999-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLACK",
        "first_name": "SAMANTHA",
        "middle_name": "MICHELLE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-02",
        "last_updated": "2018-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801093973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "LANGSTAFF",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Buford Harrison Shumaker, DDS
• Carl Albert Sigmund
• Silver Lake Counseling
• Silver Lake Family Practice PLLC
• Robert Rodney Simmons III, D.D.S.
• Kelsey Marie Slagle, LMSW
• Sleep Well Dental Center PLC
• Idalis Slotka, LLMSW
• Mitchell Jason Smelis, ATC
• Rachael Smith, PA-C

• All providers in Fenton, MI
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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.