Provider Demographics
NPI:1164878526
Name:HEAD, SAMANTHA (HSI)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:HSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1511
Mailing Address - Country:US
Mailing Address - Phone:859-441-6214
Mailing Address - Fax:859-441-3133
Practice Address - Street 1:2887 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1511
Practice Address - Country:US
Practice Address - Phone:859-441-6214
Practice Address - Fax:859-441-3133
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1092237700000X
OH3046237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist