Provider Demographics
NPI:1114347176
Name:DAVIS, SAMANTHA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6563
Mailing Address - Country:US
Mailing Address - Phone:270-442-6399
Mailing Address - Fax:270-442-6300
Practice Address - Street 1:3227 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6563
Practice Address - Country:US
Practice Address - Phone:270-442-6399
Practice Address - Fax:270-442-6300
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 0000005002235Z00000X
KYSLPLPA00193918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist