Provider Demographics
NPI:1295456234
Name:BULTER, SAMANTHA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MARIE
Last Name:BULTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3259 ELLEN PL
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14423-1226
Mailing Address - Country:US
Mailing Address - Phone:585-519-3173
Mailing Address - Fax:
Practice Address - Street 1:5550 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:NY
Practice Address - Zip Code:14066-9788
Practice Address - Country:US
Practice Address - Phone:585-493-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist