Provider Demographics
NPI:1003361718
Name:GAWTHROP, SAMANTHA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:GAWTHROP
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:MARIE
Other - Last Name:GRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF/SLP
Mailing Address - Street 1:1129 CLENDENING DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-5068
Mailing Address - Country:US
Mailing Address - Phone:954-562-9986
Mailing Address - Fax:
Practice Address - Street 1:1129 CLENDENING DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-5068
Practice Address - Country:US
Practice Address - Phone:954-562-9986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7720235Z00000X
FLSA15832235Z00000X
TN6903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018666900Medicaid
TNQ057171Medicaid