Provider Demographics
NPI:1821274994
Name:LEITER, SAMUEL D (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:D
Last Name:LEITER
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3415 CLARKS LN
Mailing Address - Street 2:APT C2
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2545
Mailing Address - Country:US
Mailing Address - Phone:443-955-3864
Mailing Address - Fax:206-888-4091
Practice Address - Street 1:1200 1ST ST NE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3361
Practice Address - Country:US
Practice Address - Phone:202-442-4800
Practice Address - Fax:202-442-5026
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0163421235Z00000X
MD05823235Z00000X
CA21469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist