Provider Demographics
NPI:1104005289
Name:MCCOMB, SAMANTHA LYNN (SLP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19081 LINDSAY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2245
Mailing Address - Country:US
Mailing Address - Phone:949-599-0218
Mailing Address - Fax:949-859-0849
Practice Address - Street 1:23361 MADERO
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2715
Practice Address - Country:US
Practice Address - Phone:949-581-8239
Practice Address - Fax:949-859-0849
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP16487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist