Provider Demographics
NPI:1851844948
Name:SAMUELS, LEAH RAE (MS SLP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RAE
Last Name:SAMUELS
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 1:2901 FINLEY RD.
Mailing Address - Street 2:STE. 102
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1774
Mailing Address - Country:US
Mailing Address - Phone:630-495-6800
Mailing Address - Fax:630-495-8200
Practice Address - Street 1:2901 FINLEY RD.
Practice Address - Street 2:STE. 102
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1774
Practice Address - Country:US
Practice Address - Phone:630-495-6800
Practice Address - Fax:630-495-8200
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242004034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist