Provider Demographics
NPI:1336879030
Name:CARR, SAMANTHA KAY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KAY
Last Name:CARR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KAY
Other - Last Name:BLANKENSHIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 CRESTLAND DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2223
Mailing Address - Country:US
Mailing Address - Phone:615-879-2132
Mailing Address - Fax:
Practice Address - Street 1:505 CRESTLAND DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2223
Practice Address - Country:US
Practice Address - Phone:615-879-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist