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NPI Code Detail

MEDICARE: SAMANTHA RAE LAROCCA MA CCC-SLP

MEDICARE: SAMANTHA RAE LAROCCA MA CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist242005589IL
2235Z00000XSpeech-Language Pathologist7762TN
3235Z00000XSpeech-Language PathologistSA21396FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NONEOTHERNONE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104437094
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA RAE LAROCCA MA CCC-SLP
Provider Business Mailing Address
First Line : 452 W ALDINE AVE APT 302
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3617
Country : US
Telephone Number : 708-606-9133
Fax Number :
Provider Business Practice Location Address
First Line : 8 S MICHIGAN AVE STE 2100
Second Line :
City : CHICAGO
State : IL
Zip : 60603-3337
Country : US
Telephone Number : 312-392-1640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 10/03/2023

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