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General NPI Number Information
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NPI Number | 1386089050
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Entity Type | Individual
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Provider Name | SAMANTHA GREGORY
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Gender | Female
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 10515 W MARKHAM ST STE E1
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2292
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Country | US
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Telephone | 501-343-4225
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 TWIN MOUNTAIN LN
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City | ROLAND
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State | AR
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Zip | 72135-9024
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Country | US
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Telephone |
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 920090677
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License Number State | AR
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