Provider Demographics
NPI:1952578163
Name:SAMUELSON, CAROL MILLER
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:MILLER
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5177 CHENEY RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9733
Mailing Address - Country:US
Mailing Address - Phone:716-763-8199
Mailing Address - Fax:
Practice Address - Street 1:5177 CHENEY RD
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14710-9733
Practice Address - Country:US
Practice Address - Phone:716-763-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012130-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist