Healthcare Provider Details

I. General information

NPI: 1467383893
Provider Name (Legal Business Name): TARA SAMPSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41831 MCALBY CT STE A
MURRIETA CA
92562-7037
US

IV. Provider business mailing address

41831 MCALBY CT STE A
MURRIETA CA
92562-7037
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-1600
  • Fax: 951-304-1601
Mailing address:
  • Phone: 951-696-1600
  • Fax: 951-304-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number38796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: