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General NPI Number Information
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NPI Number | 1730424029
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Entity Type | Individual
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Provider Name | NIRMAL K SAMANTA PHD, CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 500 CARLSON PKWY
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City | MINNETONKA
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State | MN
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Zip | 55305-5304
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Country | US
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Telephone | 877-407-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 250 BRANDY LN
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-8443
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Country | US
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Telephone | 573-450-3393
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Fax | 573-339-0911
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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 | 3531
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2004016682
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License Number State | MO
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