Provider Demographics
NPI:1063649309
Name:PITNICK, SAMANTHA LEIGH (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:PITNICK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9713 BOCA GARDENS PKWY
Mailing Address - Street 2:# C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1734
Mailing Address - Country:US
Mailing Address - Phone:561-702-8654
Mailing Address - Fax:
Practice Address - Street 1:9713 BOCA GARDENS PKWY
Practice Address - Street 2:# C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1734
Practice Address - Country:US
Practice Address - Phone:561-702-8654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist