Provider Demographics
NPI:1013645415
Name:GOSSETT, SAMANTHA PETERSON
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PETERSON
Last Name:GOSSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 OVERLOOK DRIVE
Mailing Address - Street 2:NULL
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748
Mailing Address - Country:US
Mailing Address - Phone:828-989-1563
Mailing Address - Fax:
Practice Address - Street 1:29 LOGAN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-2857
Practice Address - Country:US
Practice Address - Phone:828-226-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001029235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist