Provider Demographics
NPI:1376321331
Name:MERKEL-JOHNSON, SAMANTHA LYNNE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:MERKEL-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WESTHILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4706
Mailing Address - Country:US
Mailing Address - Phone:715-843-1058
Mailing Address - Fax:
Practice Address - Street 1:3200 WESTHILL DR STE 100
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4706
Practice Address - Country:US
Practice Address - Phone:715-843-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6424-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist