Provider Demographics
NPI:1891296844
Name:ODOM, SAMANTHA ANDREA (SLPA)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ANDREA
Last Name:ODOM
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9722 GLENWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77078-2823
Mailing Address - Country:US
Mailing Address - Phone:713-377-8620
Mailing Address - Fax:
Practice Address - Street 1:9722 GLENWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77078-2823
Practice Address - Country:US
Practice Address - Phone:713-377-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX333512355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant