Provider Demographics
NPI:1275187981
Name:COMPORT, SAMANTHA LYNN (SLP-CFY)
Entity Type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:COMPORT
Suffix:
Gender:F
Credentials:SLP-CFY
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 1276
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-6276
Mailing Address - Country:US
Mailing Address - Phone:304-842-0044
Mailing Address - Fax:304-842-0033
Practice Address - Street 1:387 HELIPORT LOOP
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-8604
Practice Address - Country:US
Practice Address - Phone:304-842-0044
Practice Address - Fax:304-842-0033
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPSLP0804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist