Provider Demographics
NPI:1487208369
Name:SCHAPPAUGH, SAMANTHA M (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:M
Last Name:SCHAPPAUGH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:M
Other - Last Name:KENDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:16 RITTER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2090
Mailing Address - Country:US
Mailing Address - Phone:309-215-5666
Mailing Address - Fax:
Practice Address - Street 1:100 EAGLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1154
Practice Address - Country:US
Practice Address - Phone:309-215-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist