Provider Demographics
NPI:1265815245
Name:BEVINGTON, SAMANTHA JANE (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:BEVINGTON
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 HASCALL ST
Mailing Address - Street 2:APT 517
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3759
Mailing Address - Country:US
Mailing Address - Phone:402-813-2245
Mailing Address - Fax:
Practice Address - Street 1:8031 W CENTER RD STE 225
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3134
Practice Address - Country:US
Practice Address - Phone:402-391-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist