Provider Demographics
NPI:1609324797
Name:WHITT, SAMANTHA DANIELLE (MS -CF/SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DANIELLE
Last Name:WHITT
Suffix:
Gender:F
Credentials:MS -CF/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 DIXON ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3470
Mailing Address - Country:US
Mailing Address - Phone:304-601-3869
Mailing Address - Fax:
Practice Address - Street 1:2145 DIXON ST
Practice Address - Street 2:APT 1
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3470
Practice Address - Country:US
Practice Address - Phone:304-601-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-17
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY169142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist