Provider Demographics
NPI:1811304926
Name:WEBB, SAMANTHA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-1512
Mailing Address - Country:US
Mailing Address - Phone:662-292-1024
Mailing Address - Fax:662-338-5439
Practice Address - Street 1:329 W TATE ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2636
Practice Address - Country:US
Practice Address - Phone:662-292-1024
Practice Address - Fax:662-796-4740
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSS3845OtherMSDH
MS03478533Medicaid