Provider Demographics
NPI:1225264450
Name:IRVINE, SAMANTHA JANE (MS)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JANE
Last Name:IRVINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1319
Mailing Address - Country:US
Mailing Address - Phone:845-633-8429
Mailing Address - Fax:
Practice Address - Street 1:9 PINECREST RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1319
Practice Address - Country:US
Practice Address - Phone:845-633-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011048-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist