Provider Demographics
NPI:1720565765
Name:SAMAHA, NOUR EHAB
Entity Type:Individual
Prefix:
First Name:NOUR
Middle Name:EHAB
Last Name:SAMAHA
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 1:216 NURA CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-7464
Mailing Address - Country:US
Mailing Address - Phone:734-444-4963
Mailing Address - Fax:
Practice Address - Street 1:3101 S GULLEY RD STE F
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4406
Practice Address - Country:US
Practice Address - Phone:734-407-2500
Practice Address - Fax:313-792-8962
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
MI7151013473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician