Healthcare Provider Details

I. General information

NPI: 1396523346
Provider Name (Legal Business Name): SAMANTHA KINGZETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 ORION PL STE 110
COLUMBUS OH
43240-4063
US

IV. Provider business mailing address

632 IPSWICH ST
WESTERVILLE OH
43081-3216
US

V. Phone/Fax

Practice location:
  • Phone: 614-734-7777
  • Fax:
Mailing address:
  • Phone: 614-359-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.16032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: