Provider Demographics
NPI:1851673982
Name:KALKOWSKI, SAMANTHA JOELLE (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JOELLE
Last Name:KALKOWSKI
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:JOELLE
Other - Last Name:BAYLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH-LANGUAGE PATH
Mailing Address - Street 1:2100 I 70 DR SW
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0099
Mailing Address - Country:US
Mailing Address - Phone:573-445-9981
Mailing Address - Fax:
Practice Address - Street 1:2100 I 70 DR SW
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-0099
Practice Address - Country:US
Practice Address - Phone:573-445-9981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011017269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505241505Medicaid