MEDICARE: AMBER SAMPSON

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1790195949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER SAMPSON

Provider Business Mailing Address
First Line	:	2025 E HERMOSA DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5906
Country	:	US
Telephone Number	:	480-517-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 E HERMOSA DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-5906
Country	:	US
Telephone Number	:	480-517-1088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2014
Last Update Date	:	04/28/2014

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Directions to “ AMBER SAMPSON ” Practice Location

Language	Start Address	Practice Location

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