Provider Demographics
NPI:1710210463
Name:COHEN, SAMANTHA (AUD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 WASHINGTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3180
Mailing Address - Country:US
Mailing Address - Phone:724-941-4434
Mailing Address - Fax:724-941-4714
Practice Address - Street 1:3240 WASHINGTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3180
Practice Address - Country:US
Practice Address - Phone:724-941-4434
Practice Address - Fax:724-941-4714
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAT005826231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023707000001Medicaid