Provider Demographics
NPI:1598338097
Name:HAUSMAN, SAMANTHA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HAUSMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CRITCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:IL
Mailing Address - Zip Code:62037-1105
Mailing Address - Country:US
Mailing Address - Phone:618-560-6303
Mailing Address - Fax:
Practice Address - Street 1:1001 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2361
Practice Address - Country:US
Practice Address - Phone:618-498-6496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist