Healthcare Provider Details

I. General information

NPI: 1427828540
Provider Name (Legal Business Name): SAMANTHA DENISE PERRY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA DENISE ARVIN

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16114 RYAN PL APT B
FORT POLK LA
71459-2546
US

IV. Provider business mailing address

16114 RYAN PL APT B
FORT POLK LA
71459-2546
US

V. Phone/Fax

Practice location:
  • Phone: 850-758-7741
  • Fax:
Mailing address:
  • Phone: 850-758-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number121926
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: