Provider Demographics
NPI:1558804682
Name:SAMSON, JAHNICE MARIE
Entity Type:Individual
Prefix:
First Name:JAHNICE
Middle Name:MARIE
Last Name:SAMSON
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 1:708 E LONGHORN RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-1102
Mailing Address - Country:US
Mailing Address - Phone:307-286-3847
Mailing Address - Fax:
Practice Address - Street 1:708 E LONGHORN RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-1102
Practice Address - Country:US
Practice Address - Phone:307-286-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services