Provider Demographics
NPI:1598288060
Name:FISHER, SAMANTHA CHARLOTTE (AUD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:CHARLOTTE
Last Name:FISHER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:CHARLOTTE
Other - Last Name:LENZINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13336 INDUSTRIAL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1124
Mailing Address - Country:US
Mailing Address - Phone:402-330-3211
Mailing Address - Fax:402-330-5970
Practice Address - Street 1:7301 N KNOXVILLE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2017
Practice Address - Country:US
Practice Address - Phone:309-589-8051
Practice Address - Fax:309-689-0312
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001794231H00000X
NE359231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist