Provider Demographics
NPI:1093079733
Name:SAMUELS, ELISHEVA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELISHEVA
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ELISHEVA
Other - Middle Name:
Other - Last Name:ZAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:7204 DONCASTER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3321
Mailing Address - Country:US
Mailing Address - Phone:757-818-3639
Mailing Address - Fax:
Practice Address - Street 1:7204 DONCASTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3321
Practice Address - Country:US
Practice Address - Phone:757-818-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist