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NPI Code Detail

MEDICARE: SAMANTHA WREN ZICKEFOOSE

MEDICARE: SAMANTHA WREN ZICKEFOOSE
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 Pathologist12131266NE

General Provider Information

NPI Number : 1336518984
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA WREN ZICKEFOOSE
Provider Business Mailing Address
First Line : 3822 CHICAGO ST
Second Line :
City : OMAHA
State : NE
Zip : 68131-2319
Country : US
Telephone Number : 402-612-9468
Fax Number :
Provider Business Practice Location Address
First Line : 3822 CHICAGO ST
Second Line :
City : OMAHA
State : NE
Zip : 68131-2319
Country : US
Telephone Number : 402-612-9468
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2015
Last Update Date : 09/24/2015

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Directions to “ SAMANTHA WREN ZICKEFOOSE ” Practice Location

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