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General NPI Number Information
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NPI Number | 1194497099
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Entity Type | Individual
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Provider Name | JACQUELINE MARIE YI MEI SAMORA MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 1215 21ST AVE S STE 9211
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City | NASHVILLE
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State | TN
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Zip | 37232-4638
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Country | US
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Telephone | 615-936-5040
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 ELLISTON PL APT 202
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City | NASHVILLE
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State | TN
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Zip | 37203-5398
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Country | US
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Telephone | 619-857-9372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 0000007628
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4826
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License Number State | TN
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