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General NPI Number Information
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NPI Number | 1477825503
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Entity Type | Individual
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Provider Name | MRS. SAMANTHA LYNN DALLEY
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Gender | Female
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 550 S IRONWOOD DR
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-5002
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Country | US
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Telephone | 480-677-7520
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Fax | 480-982-4978
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Provider Business Mailing Address
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Address Line | 2024 S BALDWIN UNIT 36
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City | MESA
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State | AZ
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Zip | 85209-1704
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Country | US
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Telephone | 480-677-7520
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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 | SLPA7012
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License Number State | AZ
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