Healthcare Provider Details

I. General information

NPI: 1992241459
Provider Name (Legal Business Name): LAMA SAMIR FARAH SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38777 6 MILE RD SUITE 209, LIVONIA MI 48152
LIVONIA MI
48152-2694
US

IV. Provider business mailing address

38777 6 MILE RD SUITE 209, LIVONIA MI 48152
LIVONIA MI
48152-2694
US

V. Phone/Fax

Practice location:
  • Phone: 866-474-6677
  • Fax:
Mailing address:
  • Phone: 866-474-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005389
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: