Provider Demographics
NPI:1114274552
Name:SAMFORD, CORDIE LEE (MS)
Entity Type:Individual
Prefix:
First Name:CORDIE
Middle Name:LEE
Last Name:SAMFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CORDIE
Other - Middle Name:LEE
Other - Last Name:MARROU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:127 NOTTINGHAM LN UNIT 2
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-2212
Mailing Address - Country:US
Mailing Address - Phone:210-618-9017
Mailing Address - Fax:
Practice Address - Street 1:221 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118-2919
Practice Address - Country:US
Practice Address - Phone:210-618-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist