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General NPI Number Information
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NPI Number | 1649937194
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Entity Type | Individual
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Provider Name | SAMANTHA JUSTINE SOROCZAK MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/19/2021
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 801 N HAMILTON ST
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City | WILLIAMSTON
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State | SC
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Zip | 29697-1061
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Country | US
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Telephone | 864-847-7344
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Fax |
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Provider Business Mailing Address
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Address Line | 823 S CHURCH ST APT 1533
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City | GREENVILLE
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State | SC
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Zip | 29601-4769
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Country | US
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Telephone | 412-334-9678
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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 | 6617
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License Number State | SC
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