Provider Demographics
NPI:1487821351
Name:SAMSON, LINDA MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:SAMSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-9608
Mailing Address - Country:US
Mailing Address - Phone:716-778-7310
Mailing Address - Fax:
Practice Address - Street 1:6025 MCKEE RD
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:NY
Practice Address - Zip Code:14108-9608
Practice Address - Country:US
Practice Address - Phone:716-778-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-10
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007630-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01482113Medicaid