=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023523974
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA DINGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2017
-----------------------------------------------------
Last Update Date | 07/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 265 S MCKEAN ST
-----------------------------------------------------
City | KITTANNING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-548-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 S MCKEAN ST
-----------------------------------------------------
City | KITTANNING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16201-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-548-2222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SL014029
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------