Provider Demographics
NPI:1942648977
Name:BOOTH, SAMANTHA J (AUD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:J
Last Name:BOOTH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WALLER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2927
Mailing Address - Country:US
Mailing Address - Phone:859-252-3170
Mailing Address - Fax:859-225-7155
Practice Address - Street 1:333 WALLER AVE STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2927
Practice Address - Country:US
Practice Address - Phone:859-252-3170
Practice Address - Fax:859-225-7155
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0571231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist