Provider Demographics
NPI:1790345346
Name:STECKLER, SAMANTHA L (MS SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:STECKLER
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 UNIVERSITY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5618
Mailing Address - Country:US
Mailing Address - Phone:701-580-8788
Mailing Address - Fax:701-609-5231
Practice Address - Street 1:140 1ST ST E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5211
Practice Address - Country:US
Practice Address - Phone:701-300-0019
Practice Address - Fax:701-609-5231
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1943235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist