Provider Demographics
NPI:1346310125
Name:SAMSEL, JAMES LOGAN (MS CF-SLP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LOGAN
Last Name:SAMSEL
Suffix:
Gender:M
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 1:613 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3005
Mailing Address - Country:US
Mailing Address - Phone:928-213-1419
Mailing Address - Fax:
Practice Address - Street 1:3036 N BOLDT DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0960
Practice Address - Country:US
Practice Address - Phone:928-773-0895
Practice Address - Fax:928-779-0896
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146879OtherAHCCCS#