Provider Demographics
NPI:1437532140
Name:GAINES-NELSON, SAMANTHA L (MS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:GAINES-NELSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 S 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-2609
Mailing Address - Country:US
Mailing Address - Phone:402-580-1903
Mailing Address - Fax:
Practice Address - Street 1:1540 S 70TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1575
Practice Address - Country:US
Practice Address - Phone:402-480-3152
Practice Address - Fax:402-904-7651
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist