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General NPI Number Information
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NPI Number | 1629701719
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Entity Type | Individual
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Provider Name | SAMANTHA NOEL RICKERT
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Gender | Female
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 5571 US ROUTE 6
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City | ANDOVER
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State | OH
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Zip | 44003-9790
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Country | US
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Telephone | 440-293-6488
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Fax | 440-293-7654
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Provider Business Mailing Address
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Address Line | 1105 BRENTWOOD DR
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City | GREENVILLE
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State | PA
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Zip | 16125-8807
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Country | US
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Telephone | 724-815-7354
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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 | SP.14979
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License Number State | OH
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