Healthcare Provider Details

I. General information

NPI: 1497399042
Provider Name (Legal Business Name): SAMANTHA ELIZABETH MEVORACH M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12304 SANTA MONICA BLVD STE 364
LOS ANGELES CA
90025-1542
US

IV. Provider business mailing address

9901 WASHINGTON BLVD
CULVER CITY CA
90232-2756
US

V. Phone/Fax

Practice location:
  • Phone: 310-270-6597
  • Fax:
Mailing address:
  • Phone: 516-987-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI4023
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP35551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: