Provider Demographics
NPI:1841937158
Name:WETZEL, SAMANTHA JANE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:WETZEL
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JANE
Other - Last Name:RAIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2000 FOUNDATION WAY STE 1200
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9030
Mailing Address - Country:US
Mailing Address - Phone:304-256-1214
Mailing Address - Fax:304-264-1331
Practice Address - Street 1:2000 FOUNDATION WAY STE 1200
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9030
Practice Address - Country:US
Practice Address - Phone:304-256-1214
Practice Address - Fax:304-264-1331
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist