Provider Demographics
NPI:1740842707
Name:GINSBURG, SAMANTHA LEAH-AUDRA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEAH-AUDRA
Last Name:GINSBURG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13837 E GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3919
Mailing Address - Country:US
Mailing Address - Phone:720-364-0710
Mailing Address - Fax:
Practice Address - Street 1:13837 E GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3919
Practice Address - Country:US
Practice Address - Phone:720-364-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0002974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO833897422Medicaid