Provider Demographics
NPI:1629701719
Name:RICKERT, SAMANTHA NOEL
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NOEL
Last Name:RICKERT
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 1:1105 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-8807
Mailing Address - Country:US
Mailing Address - Phone:724-815-7354
Mailing Address - Fax:
Practice Address - Street 1:5571 US ROUTE 6
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003-9790
Practice Address - Country:US
Practice Address - Phone:440-293-6488
Practice Address - Fax:440-293-7654
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist