Provider Demographics
NPI:1245615111
Name:DOOLITTLE, SAMANTHA LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LEE
Last Name:DOOLITTLE
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 6456
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-6456
Mailing Address - Country:US
Mailing Address - Phone:605-641-4231
Mailing Address - Fax:
Practice Address - Street 1:MOSAIC REHABILITATION
Practice Address - Street 2:6325 JACKRABBIT LN #A
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714
Practice Address - Country:US
Practice Address - Phone:406-388-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14065609ASHA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist