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General NPI Number Information
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NPI Number | 1467351890
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Entity Type | Individual
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Provider Name | SAMANTHA WILSON
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Gender | Female
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 601 RENZ AVE
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City | SELLERSBURG
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State | IN
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Zip | 47172-1331
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Country | US
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Telephone | 812-278-7271
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Fax |
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Provider Business Mailing Address
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Address Line | 3026 LOUISE WAY
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City | NEW ALBANY
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State | IN
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Zip | 47150-9376
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14091140
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License Number State | IN
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