MEDICARE: MRS. MARY CATHERINE SAMUEL MA, CCC-SLP

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	105223	MO

General Provider Information

NPI Number	:	1972106821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY CATHERINE SAMUEL MA, CCC-SLP

Provider Business Mailing Address
First Line	:	6929 WISE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3731
Country	:	US
Telephone Number	:	314-312-2984
Fax Number	:

Provider Business Practice Location Address
First Line	:	6929 WISE AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-3731
Country	:	US
Telephone Number	:	314-297-8008
Fax Number	:

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

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	11/20/2020

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