Provider Demographics
NPI:1114492733
Name:SAWATZKY, SAMANTHA JOY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JOY
Last Name:SAWATZKY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:JOY
Other - Last Name:SALOMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6022 S LINDBERGH BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-7040
Mailing Address - Country:US
Mailing Address - Phone:314-845-7751
Mailing Address - Fax:
Practice Address - Street 1:6022 S LINDBERGH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-7040
Practice Address - Country:US
Practice Address - Phone:314-845-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018033783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist