Provider Demographics
NPI:1649954330
Name:HENIGE, SAMANTHA JEWEL (MA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JEWEL
Last Name:HENIGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 CEDAR KEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1831
Mailing Address - Country:US
Mailing Address - Phone:248-891-6758
Mailing Address - Fax:
Practice Address - Street 1:1255 W SILVERBELL RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1345
Practice Address - Country:US
Practice Address - Phone:248-391-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7152000620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist