Provider Demographics
NPI:1932693678
Name:HERRICK, SAMANTHA EMILY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EMILY
Last Name:HERRICK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PASSAIC VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9677
Mailing Address - Country:US
Mailing Address - Phone:973-897-7685
Mailing Address - Fax:
Practice Address - Street 1:2282 HAMBURG TPKE STE A
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6291
Practice Address - Country:US
Practice Address - Phone:973-800-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00937900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00937900OtherSTATE LICENSE