Provider Demographics
NPI:1518454644
Name:BOLTON, SAMANTHA PAIGE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PAIGE
Last Name:BOLTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:PAIGE
Other - Last Name:FORSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:19458 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1125
Mailing Address - Country:US
Mailing Address - Phone:818-456-7965
Mailing Address - Fax:
Practice Address - Street 1:19019 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3253
Practice Address - Country:US
Practice Address - Phone:818-501-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist