Healthcare Provider Details

I. General information

NPI: 1770314668
Provider Name (Legal Business Name): SAMANTHA WULFF M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA FRICKSON

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46450 252ND ST
COLTON SD
57018-5712
US

IV. Provider business mailing address

46450 252ND ST
COLTON SD
57018-5712
US

V. Phone/Fax

Practice location:
  • Phone: 605-446-3538
  • Fax:
Mailing address:
  • Phone: 605-446-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1440-SLP
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: