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NPI Code Detail

MEDICARE: SAMANTHA CONRAD

MEDICARE: SAMANTHA CONRAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistPSLP.0000329CO

General Provider Information

NPI Number : 1124534250
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA CONRAD
Provider Business Mailing Address
First Line : 5203 FOSSIL BUTTE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80923-9502
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3625 PARKMOOR VILLAGE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-5205
Country : US
Telephone Number : 719-550-0200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2017
Last Update Date : 12/27/2017

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Directions to “ SAMANTHA CONRAD ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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