Provider Demographics
NPI:1770130015
Name:NELSON, SAMANTHA RAE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RAE
Last Name:NELSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 PECAN RD
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-1418
Mailing Address - Country:US
Mailing Address - Phone:484-885-4963
Mailing Address - Fax:
Practice Address - Street 1:489 DEVON PARK DR STE 301
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1809
Practice Address - Country:US
Practice Address - Phone:610-992-9900
Practice Address - Fax:610-992-9999
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLO14711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist